Early chemotherapy in prostate cancer

A considerable proportion of men with clinically localized prostate cancer are not cured by surgery or radiotherapy, and hormone therapy for advanced disease is also not curative. Given the demonstrable efficacy of chemotherapy in hormone-refractory disease, there is an interest in examining the curative potential of chemotherapy when administered early in the natural history of prostate cancer. It is hoped that chemotherapy could be used with hormone therapy and in the adjuvant setting, as is the case in many other solid tumors, in patients with 'high-risk' prostate cancer who are undergoing primary radical prostatectomy or radiotherapy. Early phase clinical trials have shown that using docetaxel as neoadjuvant or adjuvant therapy is safe and feasible. In the neoadjuvant setting, tumor shrinkage, serological response, there is some evidence of pathological downstaging. Several randomized trials are ongoing, and it is anticipated that the results of these studies will help to identify whether the early use of chemotherapy in early prostate cancer is beneficial.