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AUA 2016: Adjuvant Chemotherapy After Radical Prostatectomy May Benefit Men at High Risk for Relapse

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Key Points

  • Adjuvant chemotherapy in high-risk prostate cancer using docetaxel and prednisone was tolerated well by patients.
  • Of those who received chemotherapy, there was no statistically significant improvement in progression-free survival for the population as a whole; however, benefit in progression-free survival was seen in African American men  and men with higher risk pathology ≥T3b.
  • The most common ≥ grade 3 adverse events related or possibly related to chemotherapy included neutropenia in 40%, febrile neutropenia in 1.4%, hyperglycemia in 18%, and fatigue in 5%.

Not all men with prostate cancer benefit from adjuvant chemotherapy after radical prostatectomy; however, African American men and men with a higher tumor stage may, according to a new U.S. Department of Veterans Affairs (VA) study (Abstract PI LBA 06) featured at the 111th Annual Scientific Meeting of the American Urological Association (AUA).

This year, approximately 200,000 men will be told they have prostate cancer. In the United States alone, it is the leading cause of cancer in veterans and the second most common cancer in men, affecting one in seven. Odds increase to 1 in 5 if the men are African American, and 1 in 3 if they have a family history.

Each year, more than 130,000 men opt for a radical prostatectomy to treat this disease; however, because 20% to 30% of these men will be found to have locally advanced or high-grade disease, they will be at risk for relapse. As such, researchers from VA centers across the United States sought to examine the efficacy of early adjuvant chemotherapy in patients who had a radical prostatectomy, but who were, based on clinical and pathologic parameters, at high risk for relapse.

Study Details

Nearly 300 patients at high risk for relapse after prostatectomy were randomized in a 1:1 ratio to either a standard of care observation group or to a chemotherapy group where docetaxel and prednisone were administered every 3 weeks for 18 weeks. Randomization was stratified for prostate-specific antigen (PSA), Gleason score, tumor stage, and the presence of positive margins. PSA levels were monitored for a minimum of 1 year and up to a maximum of 5 years.

Results showed that adjuvant chemotherapy in high-risk prostate cancer using docetaxel and prednisone was tolerated well by patients. Of those who received chemotherapy, there was no statistically significant improvement in progression-free survival for the population as a whole; however, benefit in progression-free survival was seen in African American men (hazard ratio [HR] = 0.54, 95% confidence interval [CI] = 0.29–1.01, P = .054) and men with higher risk pathology ≥T3b (HR = 0.58, 95% CI = 0.34–0.98, logrank test = .041)

The most common ≥ grade 3 adverse events related or possibly related to chemotherapy included neutropenia in 40%, febrile neutropenia in 1.4%, hyperglycemia in 18%, and fatigue in 5%.

“What this study shows is that men with aggressive disease, thus at higher risk for prostate cancer relapse, may benefit the most from chemotherapy after radical prostatectomy,” said AUA spokesperson Sam S. Chang, MD, MBA, AUA spokesperson, Patricia and Rodes Hart Chair in Urologic Surgery, and Professor of Urologic Surgery at Vanderbilt Medical Center. “As urologists, we are always looking for new treatment options for our patients following localized therapy. Despite our best efforts, our established treatments for localized prostate cancer fail 30% of the time. Knowing to whom we should offer adjuvant chemotherapy is a real step forward in our attempts to improve our therapy success.” 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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