Abstract
A considerable proportion of men with clinically localized prostate cancer are not cured by surgery or radiotherapy, and hormone therapy for advanced disease is also not curative. Given the demonstrable efficacy of chemotherapy in hormone-refractory disease, there is an interest in examining the curative potential of chemotherapy when administered early in the natural history of prostate cancer. It is hoped that chemotherapy could be used with hormone therapy and in the adjuvant setting, as is the case in many other solid tumors, in patients with 'high-risk' prostate cancer who are undergoing primary radical prostatectomy or radiotherapy. Early phase clinical trials have shown that using docetaxel as neoadjuvant or adjuvant therapy is safe and feasible. In the neoadjuvant setting, tumor shrinkage, serological response, there is some evidence of pathological downstaging. Several randomized trials are ongoing, and it is anticipated that the results of these studies will help to identify whether the early use of chemotherapy in early prostate cancer is beneficial.
Key Points
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A substantial proportion of men with early prostate cancer are not cured by surgery or radiation
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Integrating local and systemic therapies might be beneficial in the management of high-risk localized or locally advanced prostate cancer
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Chemotherapy is effective in hormone-refractory prostate cancer
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Chemotherapy might potentially be beneficial in advanced prostate cancer when given in the adjuvant setting with hormonal therapy and, in particular, in patients with high-risk prostate cancer who are undergoing primary radical prostatectomy or radiotherapy
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To date, early phase clinical trials have shown that using docetaxel as neoadjuvant or adjuvant therapy is safe and feasible in patients with early, high-risk disease
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Several ongoing large randomized trials in the neoadjuvant and adjuvant settings will help assess whether chemotherapy is suitable for patients with early, high-risk prostate cancer
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References
Tannock IF et al. (1996) Chemotherapy with mitoxantrone plus prednisone or prednisone alone for symptomatic hormone-resistant prostate cancer: a Canadian randomized trial with palliative end points. J Clin Oncol 14: 1756–1764
Petrylak DP et al. (2004) Docetaxel and estramustine compared with mitoxantrone and prednisone for advanced refractory prostate cancer. N Engl J Med 351: 1513–1520
Tannock IF et al. (2004) Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. N Engl J Med 351: 1502–1512
D'Amico AV et al. (1998) Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 280: 969–974
Carrol PR et al. (2001) Cancer of the prostate. In Cancer Principles and Practice of Oncology, edn 6, 1418–1476 (Eds DeVita VT et al.). Philadelphia, PA: Lippincott, Williams & Wilkins
D'Amico A et al. (2003) Cancer-specific mortality after surgery or radiation for patients with clinically localized prostate cancer managed during the prostate-specific antigen era. J Clin Oncol 21: 2163–2172
D'Amico AV et al. (2004) Preoperative PSA velocity and the risk of death from prostate cancer after radical prostatectomy. N Engl J Med 351: 125–135
Eastham JA et al. (2002) Nomograms as predictive models. Semin Urol Oncol 20: 108–115
Pilepich MV et al. (2001) Phase III radiation therapy oncology group (RTOG) trial 86-10 of androgen deprivation adjuvant to definitive radiotherapy in locally advanced carcinoma of the prostate. Int J Radiat Oncol Biol Phys 50: 1243–1252
Roach M 3rd et al. (2003) Phase III trial comparing whole-pelvic versus prostate-only radiotherapy and neoadjuvant versus adjuvant combined androgen suppression: Radiation Therapy Oncology Group 9413. J Clin Oncol 21: 1904–1911
Witjes WP et al. (1997) Preliminary results of a prospective randomized study comparing radical prostatectomy associated with neoadjuvant hormonal combination therapy in T2–3 N0M0 prostatic carcinoma. Urology 49 (Suppl 3A): S65–S66
Schulman CC et al. (2000) 4-Year follow up results of a European prospective randomized study on neoadjuvant hormonal therapy prior to radical prostatectomy. Eur Urol 38: 706–713
Van Popel H et al. (1995) Neoadjuvant hormone therapy before radical prostatectomy decrease the number of positivemargins in stage T2 prostate cancer: interim results of a prospective randomized trial. J Urol 154: 429–434
Powell IJ et al. (2002) Neoadjuvant therapy before radical prostatectomy for clinical T3/T4 carcinoma of the prostate: 5-year follow-up, Phase II Southwest Oncology Group Study 9109. J Urol 168: 2016–2019
Pilepech MV et al. (1997) Phase III trial of androgen suppression using goserelin in unfavorable-prognosis carcinoma of the prostate treated with definitive radiotherapy: report of Radiation Therapy Oncology Protocol 85-31. J Clin Oncol 15: 1013–1021
Lawton CA et al. (2001) Updated results of the phase III radiation therapy oncology group (RTOG) trial 85-31 evaluating the potential benefit of androgen suppression following standard radiation therapy for unfavorable prognosis carcinoma of the prostate. Int J Radiat Oncol Biol Phys 49: 937–946
Klotz L et al. (2000) Neoadjuvant hormone therapy: the Canadian trials. Mol Urol 4: 233–238
Mazhar D et al. (2006) Improving outcomes in early prostate cancer: part I—adjuvant treatment. BJU Int 98: 725–730
Pettaway CA et al. (2000) Neoadjuvant chemotherapy and hormonal therapy followed by radical prostatectomy: feasibility and preliminary results. J Clin Onc 18: 1050–1057
Clark PE et al. (2001) Phase II trial of neoadjuvant estramustine and etoposide plus radical prostatectomy for locally advanced prostate cancer. Urology 57: 281–285
El-Rayes BF et al. (2002) Neo-adjuvant docetaxel and estramustine in patients with high risk/locally advanced prostate cancer [abstract #773]. In Proceedings of the American Society of Clinical Oncology: 2002 May 18–21; Orlando, FL
Oh WK et al. (2001) Neoadjuvant docetaxel followed by radical prostatectomy in patients with high-risk localized prostate cancer: a preliminary report. Semin Oncol 28 (Suppl 15): S40–S44
Garzotto M et al. (2002) Neoadjuvant weekly docetaxel and mitoxantrone in patients with high risk localized prostate cancer: a phase I trial [abstract #2434]. In Proceedings of the American Society of Clinical Oncology: 2002 May 18–21; Orlando, FL
Febbo PG et al. (2005) Neoadjuvant docetaxel before radical prostatectomy in patients with high-risk localized prostate cancer. Clin Cancer Res 11: 5233–5240
Magi-Galluzzi C et al. (2007) Neoadjuvant docetaxel treatment for locally advanced prostate cancer: a clinicopathologic study. Cancer 110: 1248–1254
Gleave ME et al. (2004) Multicentre phase II trial of combination neoadjuvant hormone therapy and weekly docetaxel prior to radical prostatectomy in high risk localized prostate cancer (CU0G-P01a) [abstract 4635]. Proc Am Soc Clin Oncol 23 (Suppl): 414
Prayer-Galetti T et al. (2007) Long-term follow-up of a neoadjuvant chemohormonal taxane-based phase II trial before radical prostatectomy in patients with non-metastatic high-risk prostate cancer. BJU Int 100: 274–280
Konety BR et al. (2004) Feasibility of radical prostatectomy after neoadjuvant chemohormonal therapy for patients with high risk or locally advanced prostate cancer: results of a phase I/II study. J Urol 171: 709–713
Zelefsky MJ et al. (2000) Results of a phase II study using estramustine phosphate and vinblastine in combination with high-dose three-dimensional conformal radiotherapy for patients with locally advanced prostate cancer. J Clin Oncol 18: 1936–1941
Ben-Josef E et al. (2001) Neoadjuvant estramustine and etoposide followed by concurrent estramustine and definitive radiotherapy for locally advanced prostate cancer: feasibility and preliminary results. Int J Radiat Oncol Biol Phys 49: 699–703
Schmidt JD et al. (1996) Evaluation of adjuvant estramustine phosphate, cyclophosphamide and observation only for node positive patients following radical prostatectomy and definitive irradiation. Prostate 28: 51–57
Wang J et al. (2000) Adjuvant mitoxantrone chemotherapy in advanced prostate cancer. BJU Int 86: 675–680
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Mazhar, D., Waxman, J. Early chemotherapy in prostate cancer. Nat Rev Urol 5, 486–493 (2008). https://doi.org/10.1038/ncpuro1204
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DOI: https://doi.org/10.1038/ncpuro1204
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