Modern chemotherapy strategies for management of 'Hormone Resistant Prostate Cancer' (HRPC)-When should the urologist refer?

Before death occurs from advanced prostate cancer, all patients pass through a 'hormone resistant' phase of the disease (HRPC). A large proportion of patients with advanced prostate cancer on hormonal therapy are managed in the Urology Outpatient Department, albeit with multidisciplinary input into their care. Chemotherapy for HRPC has now been shown to increase survival and quality of life and many novel agents are now undergoing Phase I and Phase II trials. The timely and appropriate referral of patients for chemotherapy, however, is essential in order to optimise patients' care and use chemotherapy wisely. This article addresses many of these practical issues.