There is considerable debate about moving chemohormonal therapy to an earlier point in the treatment of prostate cancer, at the time of initial diagnosis of metastases, according to Dr. Yu. In the pro column, “You might hit those de novo testosterone-independent clones if they exist.” Additionally, if one waits until the time of progression, some patients may be too frail to receive chemotherapy.

“The cons: a lot of people, admittedly like myself, thought there was potential for failure because when you give people [androgen-depriation therapy], it takes the cells out of the cell cycle. You get cell-cycle arrest, and your chemotherapy doesn’t do anything except add toxicity. In addition, we have data in breast cancer that shows we don’t do them together.” Furthermore, “some patients respond for a long period of time with initial [androgen-deprivation therapy] and may die of other causes and don’t even need chemotherapy. So why introduce that toxicity? That’s the debate.” ■