An interdisciplinary approach to treating prostate cancer

Urologists often are faced with challenges in treating men with metastatic prostate cancer. Although historically chemotherapy has had limited utility in treating this disease, therapeutic nihilism surrounding its use is no longer warranted, as demonstrated by results of 2 recent randomized clinical trials showing that docetaxel-based chemotherapy improves survival in patients with hormone-refractory prostate cancer (HRPC). Although the survival benefit was a modest 2 months, the results hold the promise that docetaxel-based treatment in earlier-stage disease may provide a longer survival advantage. The Cancer and Leukemia Group B (CALGB) 90203 and TAX 3501 studies are phase 3 neoadjuvant and adjuvant radical prostatectomy trials designed to assess the role of docetaxel in patients with high-risk localized disease. These 2 trials, along with the Southwest Oncology Group (SWOG) 9921 trial, which will assess the potential for adjuvant mitoxantrone, are paving the way for earlier systemic treatment. The need for better therapies for patients routinely seen in the urology clinic and the potential for improvements with chemotherapy necessitate an increasing collaboration between urologists and oncologists. Referral to a medical oncologist for a full discussion of treatment options is in the best interest of patients with HRPC, and patients at high-risk for treatment failure should be encouraged to consider clinical trial enrollment.