Comparing the safety and effectiveness of hormonal therapy alone versus chemo-hormonal therapy before prostate surgery in men with locally advanced prostate cancer

This study investigated whether adding docetaxel (Taxotere) chemotherapy to standard hormonal therapy (HT) before radical prostatectomy (RP – prostate-removal surgery) improved the survival of men with locally advanced prostate cancer (PCa) compared to hormonal therapy alone. It concluded that the addition of docetaxel-based chemo-hormonal therapy (CHT) improved the survival of these patients.

PCa is one of the most commonly diagnosed cancers in men. It is also the second leading cause of cancer-related death in men in the US. Locally-advanced PCa (LAPCa) refers to cancer that has spread from the prostate to the surrounding tissues. Due to the aggressive nature of high-risk PCa, there is a high risk of recurrence and disease progression. Patients with this type of PCa might be prescribed upfront hormone therapy or undergo androgen deprivation therapy (ADT) before radiation (RT) and surgery.  

In patients with more advanced, metastatic PCa (cancer that has spread far away from the prostate gland), adding chemotherapy drugs such as docetaxel, has improved the survival of these patients. However, the safety and effectiveness of combining docetaxel with HT before RP in men with LAPC are still under investigation. 

This study included 141 male patients with high-risk LAPCa. Patients were randomly assigned to 2 groups. Group 1 included 94 patients who were given standard HT plus docetaxel and prednisolone (Deltasone) before prostate surgery. Group 2 included 47 patients who were given standard HT before undergoing prostate surgery. The average follow-up was 53 months. 

After 3 years, significantly more patients in group 1 did not have PCa progression (29%) compared to group 2 (9.5%). Patients in group 1 had a significantly longer average survival without PCa return (17 months) compared to group 2 (14 months). After treatment, slightly more patients in group 1 had a PCa downstaging compared to group 2 (65% vs 48%).

This study concluded that docetaxel-based CHT before prostate surgery was associated with improved survival without cancer worsening compared to HT alone in men with high-risk LAPCa.

The study was done in a mostly Chinese population. The population size was relatively small and the follow-up period was relatively short. Larger, long-term studies are needed to validate the results.