Prostate cancer: Multimodality approaches with docetaxel

Abstract

The trend toward earlier diagnosis of prostate cancer and technological advances in radiotherapeutics (eg, imaging enhancement, planning optimization, refinement of calculation algorithms, and computerized delivery systems) have led to increased use of radiation therapy (RT) as primary treatment for presumed localized disease. However, monomodal local therapy fails to achieve consistently successful long-term disease control, especially in patients with intermediateand high-grade risk factors. Local-regional factors, such as absolute and relative resistance mechanisms, epigenetic influences, and clonogenic heterogeneity, and probable micrometastatic disease require consideration, evaluation, and potentially the implementation of combined modality approaches. Patients receiving combined RT and androgen suppression (AS) in various sequences (AS → AS + RT, AS + RT, AS → AS + RT → AS, and RT → AS) have shown enhanced diseasefree survival, increased pathologic local control related to the duration of AS treatment, and improved overall survival with prolonged AS. Furthermore, limited but provocative trials suggest that multimodality chemoradiotherapy may also enhance tumor control in patients with locally advanced disease with acceptable toxicity. Several new trials that will test the efficacy and safety of docetaxel combined with radiotherapy as well as biologic modifiers are described.