MP82-18 EFFECT OF NEOADJUVANT DOCETAXEL CHEMOTHERAPY COMBINED WITH ADJUVANT CHEMOTHERAPY COMPARED WITH RADICAL PROSTATECTOMY ALONE IN PATIENTS WITH HIGH RISK PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Advanced II1 Apr 2015MP82-18 EFFECT OF NEOADJUVANT DOCETAXEL CHEMOTHERAPY COMBINED WITH ADJUVANT CHEMOTHERAPY COMPARED WITH RADICAL PROSTATECTOMY ALONE IN PATIENTS WITH HIGH RISK PROSTATE CANCER Wansuk Kim, Cheryn Song, and Hanjong Ahn Wansuk KimWansuk Kim More articles by this author , Cheryn SongCheryn Song More articles by this author , and Hanjong AhnHanjong Ahn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.537AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Preoperative chemotherapy with androgen deprivation therapy is under investigation, some with promising results. However, the definitive value of preoperative and postoperative chemotherapy-only therapy remains unevaluated for high risk prostate cancer. We investigated the efficacy of docetaxel treatment before and after radical prostatectomy (RP) in patients with high risk prostate cancer. METHODS Patients with high risk prostate cancer according to D'Amico criteria were prospectively randomized to one of two treatment groups: neoadjuvant chemotherapy (three cycles) followed by RP (arm A, n=27); or RP alone (arm B, n=21). Patients in arm A were treated with 75 mg/m2 IV docetaxel every three weeks following premedication with 8 mg of dexamethasone; they then underwent RP two weeks later. After RP, 17 patients in group A were treated with docetaxel with same schedule. The median observation time was 50.74 months in both arms. RESULTS There were no differences in the age (66.6 and 64.2 years, p=0.080), pretreatment PSA levels (23.9 and 16.2 ng/mL, p=0.052), clinical stage and Gleason score between the patients in arm A and B, respectively. Grade 1-2 non-hematologic toxicities occurred in 13 patients (81.3%), none with grade 3-4 toxicities. The pathological stages were: T2 in 4(23.5%), T3a in 8(47.1%), and T3b in 5 (29.4%) in arm A; T2 in 5(23.8%), T3a in 8(38.1%), and T3b in 8(38.1%) in arm B (p=0.914). Positive margin rate was similar between the arms in pT2 patients while in pT3 patients it was lower in arm A (37.5% vs. 90.9%, p=0.008). PSA response (> 25% reduction) after chemotherapy was observed in 8 patients (50.0%), but pathological downstaging was noted in 2 (12.5%). After RP, 6 and 7 from each group failed to reach undetectable PSA. PSA failure rate was 27.3%, 50.0% in arm A and B respectively (p=0.414). CONCLUSIONS Docetaxel neoadjuvant chemotherapy lowers positive resection margin in patients with high risk prostate cancer. However, pathological downstaging or immediate oncological result was observed only in a limited number of patients who demonstrated substantial PSA response. But there was no difference in biochemical recurrence free survival. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1044 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wansuk Kim More articles by this author Cheryn Song More articles by this author Hanjong Ahn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...