Stage D2 disease may produce symptoms from the prostate gland or from sites of metastatic disease, or it may be asymptomatic. Asymptomatic patients may be followed closely until symptoms occur. Alternatively, some experts favor immediate institution of hormone ablative therapy at the first evidence of metastatic disease. Urinary tract obstruction, if present, should be relieved promptly. Systemic therapy should be initiated in patients who have hydronephrosis, spinal cord compression, or osseous pain from metastatic disease.
Androgen deprivation can often produce regression of disease and improvement of symptoms.
The goal of androgen deprivation is to achieve castrate levels of testosterone and dihydrotestosterone. Androgen deprivation produces subjective improvement in about 80 percent of patients and objective evidence of tumor regression in nearly 50 percent. The response to endocrine manipulation appears to be correlated with the concentration of dihydrotestosterone and androgen receptors in the cancerous prostate tissue. However, methods of measuring these factors are not widely available. Although it is often done, there is little benefit in using a second hormone therapy in a patient whose condition initially responds to one form of hormone therapy but then becomes refractory to it.