Chemotherapy agents and timing of chemotherapy in prostate cancer management

In 2005, it is estimated that more than 30,000 men will die from metastatic hormone-refractory prostate cancer. For decades, no chemotherapeutic agent demonstrated a survival benefit in these patients, although two randomized clinical trials demonstrated a clear palliative benefit using mitoxantrone combined with a corticosteroid. However, beginning in 1999, a series of phase-2 trials were performed using docetaxel, either as a single agent or in combination with estramustine. Preliminary data implied a survival improvement, with median survivals reported to be 14 to 23 months. Prostate-specific antigen levels dropped by more than 50% in 38% to 48% of patients treated with docetaxel. These findings were confirmed in two phase-3 randomized trials in which docetaxel with and without estramustine have demonstrated a survival benefit using chemotherapy in the treatment of hormone-refractory prostate cancer.