Reviewer: Chika Madu, MD
Abramson Cancer Center of the University of Pennsylvania
Last Modified: October 20, 2005
Presenter: H.M. Sandler
Presenter's Affiliation: University of Michigan, Ann Arbor, MI
Type of Session: Scientific
The current standard of care for patients with high risk prostate cancer includes local radiotherapy in conjunction with long-term androgen ablation (LTAA). However, recurrence and metastasis following treatment continues to be problematic in this group of patients. Chemotherapy in the past has been used to salvage hormone refractory metastatic cancer with about a 50% PSA response. The goal of this study was then to evaluate the role of chemotherapy in the adjuvant setting for high risk prostate cancer patients.
Materials and Methods
The goal of this study was to show an overall survival advantage when chemotherapy is used adjuvantly with current standard of care for high risk prostate cancer. This study closed early due to toxicity most likely related to estramustine. There were 6 TEs in the chemotherapy group and the authors are unaware of any prior history or predilection for TE in the affected patients. It is clear that the disease free survival rates and overall survival rates with standard radiation and LTAA leave more to be desired, but the toxicities associated with certain chemotherapy agents, may not be worth any presumed survival advantage, if any. The use of less toxic chemotherapy may be more useful to evaluate the role of chemotherapy in this setting. An upcoming trial will be RTOG 05-21 which will randomize high risk prostate cancer patients to radiation (72-75.6Gy) and 28 months of androgen ablation plus or minus 6 cycles of the more tolerable docetaxel and prednisone. It will be interesting to see the results of this study, especially with a more standard radiation dose.