For patients with locally advanced prostate cancer, combined treatment with chemotherapy and hormonal therapy offers prolonged control of prostate-specific antigen (PSA) levels, in comparison with hormonal therapy alone, reports a study within the April issue of The Journal of Urology^®, an Official Journal of the American Urological Association (AUA). The journal is published within the Lippincott portfolio by Wolters Kluwer.

Our clinical trial is the primary to indicate an extended time to biochemical reoccurrence with chemotherapy plus standard hormone therapy for patients with locally advanced, high-risk prostate cancer. The findings add recent evidence to support using combined chemohormonal therapy for a bunch of patients at high risk of recurrent, progressive prostate cancer.”

Jiahua Pan of Shanghai Jiao Tong University, People’s Republic of China

Chemohormonal therapy for high-risk, locally advanced prostate cancer

The randomized controlled trial included 141 men with locally advanced prostate cancer, by which cancer has spread outside the prostate to nearby tissues. All patients had clinical characteristics placing them at elevated risk of distant tumor spread (metastasis) after initial treatment.

In a 2:1 ratio, patients were randomly assigned to treatment with the chemotherapy agent docetaxel plus hormonal (androgen deprivation) therapy or hormonal therapy alone. In each groups, these “neoadjuvant” treatments were followed by surgery (radical prostatectomy and prolonged lymph node dissection).

The study focused on biochemical progression-free survival – control of serum PSA levels – as an indication of tumor control. Rising PSA levels are an early sign of recurrent or progressive prostate cancer. The study also checked out pathologic responses: whether the study treatments were effective in shrinking the prostate cancer before surgery.

Addition of chemotherapy prolongs time to rising PSA levels

Each groups had good pathologic responses: the cancer was “downstaged” before surgery in 65% of patients assigned to chemohormonal therapy and 48% of with hormonal therapy only. The 2 groups also had similar rates of minimal residual disease – only a small variety of cancer cells remaining after treatment.

Chemohormonal therapy had a greater effect on biochemical progression-free survival. At three years’ follow-up, 29% of patients receiving chemotherapy plus hormonal therapy remained freed from rising PSA levels, in comparison with 9.5% with hormonal therapy only.

Median time to rising PSA levels was 17 months with chemohormonal therapy versus 14 months with hormonal therapy alone. Patients receiving chemotherapy also had a better treatment-free survival rate: 8.5% required no further prostate cancer treatment through five years’ follow-up. The 2 groups had similarly low complication and hostile event rates.

By itself, neoadjuvant hormonal therapy can improve tumor control in locally advanced prostate cancer, but studies have shown limited effects on patient survival. The mixture of docetaxel chemotherapy and hormonal therapy has yielded inconsistent results, likely reflecting differences between studies.

The brand new study is the primary to indicate improvement in biochemical reoccurrence rate with chemohormonal therapy on this group of patients. The outcomes also point to possible improvements in other essential outcomes.

The authors note that their study is proscribed by relatively short follow-up times – making it not possible to guage the consequences on “more clinically significant endpoints,” including overall survival and risk of death as a result of prostate cancer. “Our study suggests that neoadjuvant docetaxel-based chemotherapy could bring significant improvement for patients,” the researchers write. They emphasize, “longer follow-up is required for more supportive evidence.”