Adjuvant chemotherapy for T3 prostate cancer: not ready for prime time

Abstract

Recent reviews of prostatectomy as monotherapy for T3 prostate cancer have suggested that adjuvant therapy is required. 1 van den Ouden D. Hop W.C. Schroder F.H. Progression in and survival of patients with locally advanced prostate cancer (T3) treated with radical prostatectomy as monotherapy. J Urol. 1998; 160: 1392-1397 Abstract Full Text Full Text PDF PubMed Scopus (132) Google Scholar , 2 Gerber G.S. Thisted R.A. Chodak G.W. et al. Results of radical prostatectomy in men with locally advanced prostate cancer multi-institutional pooled analysis. Eur Urol. 1997; 32: 385-390 PubMed Google Scholar , 3 Lerner S.E. Blute M.L. Zincke H. Extended experience with radical prostatectomy for clinical stage T3 prostate cancer outcome and contemporary morbidity. J Urol. 1995; 154: 1447-1452 Abstract Full Text Full Text PDF PubMed Scopus (128) Google Scholar , 4 Yamada A.H. Lieskovsky G. Petrovich Z. et al. Results of radical prostatectomy and adjuvant therapy in the management of locally advanced, clinical stage TC, prostate cancer. Am J Clin Oncol. 1994; 17: 277-285 Crossref PubMed Scopus (38) Google Scholar In limited and uncontrolled series, adjuvant therapy has meant the addition of external beam radiation or endocrine therapy. Few or no published studies on the use of adjuvant chemotherapy for T3 prostate cancer exist that have adequate follow-up to allow for an appropriate interpretation of the results. The question of adjuvant chemotherapy for T3 prostate cancer stems from two impulses. First, it is easy to extrapolate successes in adjuvant therapy from other tumor types. Second, chemotherapy is seen to be emerging as a viable, tolerable, and efficacious strategy in advanced refractory prostate cancer. Despite the perceived improvements in the management of advanced prostate cancer, no clinical justification has emerged for the use of adjuvant chemotherapy in patients with T3 prostate cancer after surgery.