A neoadjuvant chemohormonal therapy combination may offer extended control of prostate-specific antigen (PSA) levels in patients with locally advanced prostate cancer compared with hormonal therapy alone, according to a recent study published by Qian et al in The Journal of Urology.
Background
Increasing PSA levels may be an early sign of recurrent or progressive prostate cancer. Neoadjuvant hormonal therapy has been shown to improve tumor control in locally advanced prostate cancer, but studies have reported a limited impact on patient survival.
Study Methods and Results
In the recent study, researchers randomly assigned 141 patients with locally advanced prostate cancer and clinical characteristics that increased their risk of distant tumor metastasis after initial treatment to receive the chemotherapy agent docetaxel plus androgen-deprivation therapy or androgen-deprivation therapy alone. Both groups then underwent radical prostatectomy and extended lymph node dissection.
They examined biochemical progression-free survival and control of serum PSA levels as a sign of tumor control as well as pathologic responses to determine whether the chemohormonal therapy was effective at shrinking prostate cancer prior to surgery.
The researchers found that both groups experienced positive pathologic responses and similar rates of measurable residual disease. Prostate tumors were downstaged prior to surgery in 65% of the patients who received chemohormonal therapy and 48% of those who received androgen-deprivation therapy alone.
However, after a follow-up of 3 years, 29% of the patients given chemohormonal therapy remained free of rising PSA levels compared with 9.5% among those given androgen-deprivation therapy alone. Further, the median time to rising PSA levels in the patients who received chemohormonal therapy was 17 months vs 14 months among the patients who received androgen-deprivation therapy alone. The researchers also noted that the patients who received the combination therapy had a higher treatment-free survival rate, and 8.5% of them required no further prostate cancer treatment after 5 years. Both groups demonstrated similarly low complication and adverse event rates.
Conclusions
“Our clinical trial is the first to show a longer time to biochemical recurrence with chemotherapy plus standard hormonal therapy for patients with locally advanced, high-risk prostate cancer. The findings add new evidence to support the use of combined chemohormonal therapy for a group of patients at high risk of recurrent, progressive prostate cancer,” underscored co–study author Jiahua Pan, MD, of the Shanghai Jiao Tong University.
The researchers indicated that the combination therapy has previously yielded inconsistent results, reflecting potential differences among studies. Nonetheless, the recent findings showed improvements in the biochemical recurrence rate and other outcomes with chemohormonal therapy in this patient population.
Because the study was limited by relatively short follow-up, it may be challenging to evaluate the effects on more clinically significant endpoints—including overall survival and risk of prostate cancer–related mortality.
“Our study suggests that neoadjuvant docetaxel-based chemotherapy could bring significant improvement for patients. [L]onger follow-up is needed for more supportive evidence,” the study authors concluded.
Disclosure: For full disclosures of the study authors, visit auajournals.org.
