High-risk prostate cancer: Is there a survival benefit when chemotherapy is administered before surgery?

This study examined the benefit of administering chemotherapy before prostate surgery in men with intermediate- to high-risk prostate cancer. Researchers reported preliminary evidence of a cancer-specific survival benefit when chemotherapy was administered before surgery.

Prostate surgery is a first-line treatment for localized (confined) prostate cancer. Men with high-risk prostate cancer are at increased risk of disease recurrence after treatment. Intensive treatment is therefore needed early on.

Chemotherapy, such as docetaxel (Taxotere), is the standard of care for advanced prostate cancer. Some studies are suggesting that administering chemotherapy early, before prostate surgery, can improve treatment response in men with high-risk disease. Whether administering chemotherapy early also offers a survival benefit is still being investigated.

The aim of this study was to examine the benefit of administering chemotherapy before prostate surgery.

44 men with intermediate- to high-risk prostate cancer were included in this study. 23 of these men received treatment with prostate surgery only. 21 men were treated with six cycles of docetaxel before undergoing surgery. Patients were followed for 128.4 to 141.6 months.

Side effects associated with chemotherapy were mostly mild and observed in less than 10% of men. Low platelet counts, fatigue, high blood sugar, and hair loss were among the most commonly reported. Chemotherapy did not delay prostate surgery in any cases.

95.3% of men showed a significant reduction in PSA levels (prostate specific antigen; a protein elevated in the blood in prostate cancer) after chemotherapy and before surgery. A reduction in PSA levels of at least 50% was observed in 52.4% of men. Prostate size was reduced in all men treated with chemotherapy.

90% of men treated with chemotherapy and surgery did not die from cancer during the study period. This was significantly higher compared to 60.9% of men treated with surgery only. However, overall survival (time from treatment until death from any cause) was similar between the two groups. Overall survival was 54.6% in the surgery only group and 75.5% in the chemotherapy plus surgery group. Disease recurrence (based on blood tests) occurred in 60.9% of men in the surgery only group and in 42.9% of men treated with chemotherapy and surgery.

No significant differences in complications following surgery were observed between the two groups. 9.5% of men treated with chemotherapy and surgery and 13% of men treated with surgery reported serious side effects.

Researchers concluded that administering chemotherapy before prostate surgery is safe and may offer a cancer-specific survival advantage for men with high-risk disease.

Larger studies are needed to confirm these findings.