There are many treatment options available for persons with prostate cancer, including surgery, chemotherapy, and/or radiation therapy. One of the most common treatments for localized prostate cancer is a surgery, called a radical prostatectomy, but this procedure is more difficult for cancers that have spread outside the prostate area. Now, researchers in Texas have developed a strategy of using chemotherapy before surgery, which may allow these cancers to be reduced to a size at which they can be completely removed during a prostatectomy.

Cancer of the prostate, a male sex gland located near the bladder and rectum, is a type of cancer that occurs commonly in older men. One test that may be performed to help indicate whether prostate cancer is suspected is a blood test for prostate-specific antigen (PSA), a protein produced by the prostate cells. If PSA levels are high, prostate cancer is more likely, and further tests are needed for diagnosis. Once prostate cancer is diagnosed, doctors must determine the stage (the extent of disease at diagnosis) and grade (how quickly the cancer is likely to grow) of the cancer. Doctors often use a system called the Gleason score to indicate the grade of disease, with a higher score indicating the likelihood of faster growth.

Treatment for prostate cancer depends on the stage, grade of disease, and preference of the patient. Treatment approaches may include delaying treatment until the cancer progresses, or surgery, radiation therapy, brachytherapy (use of radiation placed in the prostate), hormone therapy, chemotherapy, and/or biologic therapy to help the immune system fight the cancer. A radical prostatectomy is a surgical procedure to remove the prostate gland and some of the surrounding tissue, for persons in whom prostate cancer is localized, or has not spread outside the prostate gland. A pelvic lymph node dissection, meaning the removal of the lymph nodes around the prostate, may be done before the radical prostatectomy to determine whether these lymph nodes contain cancer cells. Researchers continue to develop new treatment strategies, including new chemotherapy drugs and new ways to combine different therapies, to achieve better outcomes.

Researchers at MD Anderson Cancer Center treated 33 persons with prostate cancer for whom the removal of all the cancer during surgery was likely to be difficult. These included men with stage I to II cancer with a Gleason score of 8 or more and men with stage II cancer with a Gleason score of 7 and a PSA level of more than 10 ng/mL. All the patients received 12 weeks of chemotherapy, followed by a prostatectomy. The chemotherapy was well tolerated and there were no surgical complications as a result of the chemotherapy. In 83% of the patients, the surgeons were able to remove all of the cancer during surgery. The PSA levels of all patients were reduced to undetectable amounts after surgery. One year later, 29 persons are alive and 20 have had no recurrence (return) of the cancer.

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These findings show that chemotherapy given before prostatectomy is a feasible treatment for persons who are unlikely to have complete removal of all cancer of the prostate. Further studies are needed to develop more effective chemotherapy regimens and to determine whether this strategy will prevent the spread of cancer and improve survival. This may be a particularly promising approach for men with advanced disease. Persons who have prostate cancer may wish to talk with their doctor about the possible use of chemotherapy before surgery, or of participating in a clinical trial in which other new treatment approaches are being studied. Sources of information on ongoing clinical trials that can be discussed with a doctor include a comprehensive, easy-to-use service provided by the National Cancer Institute (cancer.gov) and the Clinical Trials section and service offered by Cancer Consultants.com (www.411cancer.com). (Journal of Clinical Oncology, Vol 18, No 5, pp 1050-1057, 2000)

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