Combined chemohormone therapy for locally advanced prostate cancer provides extended control of PSA levels

Combined chemohormone therapy for locally advanced prostate cancer provides extended control of PSA levels

In patients with locally advanced prostate cancer, combined treatment with chemotherapy and hormone therapy provides enhanced control of prostate-specific antigen (PSA) levels compared to hormone therapy alone, a study reports in the April issue ofThe Journal of Urology®, an official journal of the American Urological Association (AUA). The journal is published in the Lippincott portfolio of Wolters Kluwer.

Our clinical trial is the first to demonstrate a longer time to biochemical recurrence with chemotherapy plus standard hormonal therapy in patients with locally advanced, high-risk prostate cancer. The results provide new evidence to support the use of combined chemohormone therapy in a group of patients at high risk of recurrent, progressive prostate cancer.”

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

Chemohormonal therapy for high-risk, locally advanced prostate cancer

The randomized, controlled trial involved 141 men with locally advanced prostate cancer, where the cancer had spread outside the prostate to surrounding tissue. All patients had clinical features that placed them at increased risk of distant tumor spread (metastasis) after initial treatment.

In a 2:1 ratio, the patients were randomly assigned to treatment with the chemotherapy drug docetaxel plus hormone therapy (androgen deprivation) or hormone therapy alone. In both groups, these “neoadjuvant” treatments were followed by surgical procedures (radical prostatectomy and extended lymph node dissection).

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

The additional chemotherapy prolongs the time until the PSA level rises

Both groups showed good pathological responses: the cancer was “downstaged” before surgery in 65% of patients who received chemohormone therapy and in 48% of patients who received hormone therapy alone. The two groups also had similar rates of minimal residual disease – only a small number of cancer cells remained after treatment.

Chemohormone therapy had a greater effect on biochemical progression-free survival. After three years of follow-up, 29% of patients who received chemotherapy plus hormone therapy had no rising PSA levels, compared with 9.5% who received hormone therapy alone.

The median time to rise in PSA levels was 17 months with chemohormone therapy compared to 14 months with hormone therapy alone. Patients who received chemotherapy also had a higher treatment-free survival rate: 8.5% did not require further prostate cancer treatment by five-year follow-up. The two groups had similarly low complication and side effect rates.

Neoadjuvant hormonal therapy alone can improve tumor control in locally advanced prostate cancer, but studies have shown limited impact on patient survival. The combination of docetaxel chemotherapy and hormone therapy has produced inconsistent results, likely due to differences between studies.

The new study is the first to show an improvement in biochemical recurrence rates with chemohormone therapy in this patient group. The results also suggest possible improvements in other important outcomes.

The authors note that their study is limited by relatively short follow-up periods – making it impossible to assess the impact on “more clinically meaningful endpoints,” including overall survival and the risk of death from prostate cancer. “Our study suggests that docetaxel-based neoadjuvant chemotherapy could provide significant improvement for patients,” the researchers write. They emphasize: “Longer follow-up is needed for more supporting evidence.”

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