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Early chemotherapy in prostate cancer

Nature Clinical Practice Urology volume 5, pages 486–493 (2008)Cite this article

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

  • A substantial proportion of men with early prostate cancer are not cured by surgery or radiation

  • Integrating local and systemic therapies might be beneficial in the management of high-risk localized or locally advanced prostate cancer

  • Chemotherapy is effective in hormone-refractory prostate cancer

  • 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

  • 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

  • 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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Authors and Affiliations

  1. D Mazhar is a Consultant Medical Oncologist based in Addenbrooke's Hospital, Cambridge,

    Danish Mazhar

  2. J Waxman is a Professor of Oncology at the Hammersmith Hospital, London, UK.,

    Jonathan Waxman

Authors
  1. Danish Mazhar
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  2. Jonathan Waxman
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Correspondence to Jonathan Waxman.

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The authors declare no competing financial interests.

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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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