Beyond the Abstract - Adjuvant medical therapy for prostate cancer, by Thomas W. Flaig, MD

BERKELEY, CA (UroToday.com) - Even though prostate cancer is the most common cancer in men, the appropriate role of adjuvant medical therapy is largely undefined.

While this is especially true of perioperative chemotherapy, there are a few supported uses of periprocedural hormonal therapy in prostate cancer patients. In those with lymph node positive disease at the time of surgery, early and prolonged androgen deprivation therapy (ADT) has been shown to give an improvement in overall survival. In addition, the use of ADT in conjunction with and after completion of radiation therapy is superior to radiation-alone in higher risk prostate cancer patients.

In contrast, there is a general paucity of evidence to support the utility of perioperative chemotherapy in men with prostate cancer. While adjuvant chemotherapy has a proven role in many other cancer types (including breast, colon and lung cancer), the role of adjuvant chemotherapy in prostate cancer is yet to be define. To be clear, it is not that there is a literature of negative data to refute the role of adjuvant chemotherapy for prostate cancer, but rather, there is an absence of any modern, high-quality data to guide us. A large contemporary trial designed to address this question, SWOG 9921, compared the use of ADT with or without mitoxantrone chemotherapy in men with high-risk features at the time of prostatectomy. Unfortunately, several cases of acute myelogenous leukemia were observed in the mitoxantrone treatment group and the trial was closed for this reason before completing accrual. Despite this closure, with nearly 1000 subjects, this study may still be able to contribute important insight on the role of adjuvant chemotherapy for prostate cancer, with additional follow-up.

Over the last several years, there have been notable advances in the medical treatment options for advanced prostate cancer. These developments have led to the approval of both a new chemotherapy agent (Cabazitaxel) and also an autologous cellular immunotherapy treatment (Sipuleucel-T) for metastatic, castration-resistant prostate cancer. Additionally, a recent phase 3 study of a novel oral hormonal agent (abiraterone acetate) in men with progressive prostate cancer despite docetaxel chemotherapy has now been reported. Abiraterone acetate plus prednisone statistically improved the overall survival compared to those treated with prednisone-alone in this setting. With the emergence of these new and effective agents for prostate cancer, renewed consideration must be given to the potential adjuvant and periprocedural use of these new medical therapies in selected, high-risk prostate cancer patients.

 

Written by:
Thomas W. Flaig, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

 

Adjuvant medical therapy for prostate cancer - Abstract

UroToday.com Prostate Cancer Section

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