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Results from a recent clinical trial published in the BJU International suggest that the combination of the chemotherapy agent mitozantrone plus hormonal therapy may extend survival by over 3 years compared to hormonal therapy alone in patients with locally advanced prostate cancer.

Cancer of the prostate, a male sex gland located between the bladder and rectum, occurs commonly in older men. There are many treatment options available for patients with this disease. Treatment depends on the extent of the disease, but may consist of surgery, delaying treatment until the cancer progresses, radiation therapy, hormone therapy, biologic therapy (utilizing the body’s immune system to fight cancer), and/or chemotherapy. Patients with advanced localized prostate cancer have cancer that has spread outside the prostate, but not to distant sites in the body. Controversy exists regarding the optimal treatment strategy for patients with this disease, but some recent trials have suggested that a multi-modality approach may produce superior outcomes compared to the use of single therapies. Current clinical trials are ongoing in an attempt to determine the most effective treatment strategies and combinations for patients with locally advanced prostate cancer.

Prostate cancer is stimulated to grow by naturally occurring male hormones called androgens. A type of treatment called hormone therapy is aimed at lowering the levels of androgens (particularly testosterone) available to the cancer, thereby eliminating its source for growth. This can be achieved in two ways: through lowering the levels of androgen production in the body, or blocking the cancer stimulating effects of androgens on cancer cells.

Recently, researchers in England conducted a clinical trial evaluating treatment consisting of hormone therapy plus the chemotherapy agent mitozantrone versus hormone therapy alone for patients with locally advanced prostate cancer. Hormone therapy in this trial consisted of injections of an agent that reduced the production of androgens (particularly testosterone) in the body. Ninety-five percent of patients who received the combination treatment experienced a complete or partial disappearance of their cancer, compared to only 53% of patients who received only hormone therapy. Importantly, the average duration of survival following therapy was significantly higher in patients who received both mitozantrone and hormone therapy, nearly 7.5 years, compared to 3 years for patients receiving only hormone therapy.

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These results are important in helping to define optimal treatment strategies for patients with locally advanced prostate cancer. Researchers who performed this study are encouraged by the results, and are calling for an extension of this clinical trial to further assess the implications of the treatment combination including mitozantrone and hormone therapy. Patients with locally advanced prostate cancer may wish to speak with their physicians about the risks and benefits of this treatment combination or participation in a clinical trial evaluating promising new treatments.

Two sources of information about ongoing clinical trials include comprehensive, easy-to-use listing services provided by the National Cancer Institute (cancer.gov) and eCancerTrials.com. eCancerTrials.com also provides personalized clinical trial searches on behalf of patients. (BJU International, Vol 86, pp 675-680, 2000)

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