According to results presented at the 99th annual meeting of the American Urological Association, treatment consisting of chemotherapy plus hormone therapy together does not improve survival compared to hormone therapy followed by chemotherapy in advanced prostate cancer.

Prostate cancer is the most common cancer in men in the United States. Each year, nearly 30,000 men will die from the disease. The prostate is a walnut-sized gland that is located between the bladder and the rectum. It is responsible for forming a component of semen. Once a patient’s cancer has spread from the prostate to distant sites in the body following prior therapy, the optimal treatment strategy has not yet been determined. However, treatment referred to as hormone therapy is widely used. Hormone therapy reduces the levels of male hormones, particularly testosterone, in the body, as these hormones have been implicated in the development and/or growth or prostate cancer cells. Researchers have also been evaluating the role of chemotherapy in advanced prostate cancer, particularly the timing in which chemotherapy and hormone therapy are used in a treatment regimen.

Researchers from MD Anderson Cancer Center in Houston, Texas recently completed a clinical trial to directly compare different scheduling of hormone therapy and chemotherapy in the treatment of advanced prostate cancer. This trial included 289 patients, a large majority of whom had cancer spread to the bone. Patients were treated with either hormone therapy plus chemotherapy together, or initial hormone therapy alone followed by chemotherapy at the time the cancer stopped responding to hormone therapy. With a follow-up of approximately 4 years, patients treated with chemotherapy plus hormone therapy together had a longer duration of progression-free survival; however, the improvement was restricted to patients with more advanced disease in the bone. Overall, there was no difference in survival between the two groups of patients, with the average duration of survival being approximately 52 months. Death from prostate cancer was also the same between the two groups of patients.

The researchers concluded that overall survival and death from prostate cancer are similar between treatment consisting of hormone therapy plus chemotherapy together, or hormone therapy followed by chemotherapy at the time of cancer progression in patients with advanced prostate cancer. The researchers stated that treatment utilizing therapy targeted against cancer that has spread to the bone may improve outcomes, and clinical trials evaluating this treatment option are warranted. Patients with advanced prostate cancer may wish to speak with their physician about their individual risks and benefits of treatment with hormone therapy, chemotherapy and/or bone targeted therapy, or the participation in a clinical trial evaluating other novel therapeutic approaches. Two sources of information regarding ongoing clinical trials include the National Cancer Institute ( cancer.gov) and www.cancerconsultants.com. Personalized clinical trial searches are performed by cancerconsultants.com.

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Reference: Preliminary results of a phase III trial of hormonal therapy vs. chemohomronal therapy as initial treatment for non-localized prostate cancer. Proceedings from the 99th annual meeting of the American Urological Association. 2004; 171: Abstract 1459.

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