Molecular Therapeutics in Prostate Cancer

The purpose of this chapter is to provide information on the molecular basis of prostate cancer biology, to identify some of the targets for therapy, and to highlight some potential strategies for molecular treatment The understanding of the molecular processes that occur in the development and progression of prostate cancer can lead to novel therapies that will provide longer survival, better quality of life, and a chance for cure in men afflicted with this disease. Prostatic intraepithelial neoplasia is the histologic abnormality most commonly associated with prostate cancer and is proposed as a precursor of invasive prostate cancer. Androgen regulates both the development of the prostate and many aspects of prostate cancer growth. Prostate cancers are initially composed of a majority of cells that require androgen for proper growth, the lack of which can cause these cells to die. Androgen withdrawal is the only effective treatment modality for advanced prostate cancer, providing an objective response in the majority of patients. Interactions between prostate cells and stromal cells are important in every aspect of prostate regulation. Beginning with development of the prostate in utero, continuing with postpubertal growth and differentiation, through the development of BPH and prostate cancer later in life, stromal–epithelial interactions are a driving force determining how a prostate behaves. These interactions can also accelerate local prostate cancer growth, stimulate distant metastatic tumors, and are also involved in the development of hormone independence.