September 20, 2014

   A Publication of the James Buchanan Brady
   Urological Institute Johns Hopkins Medical Institutions

Volume II, Autum 2005

Is Prostate Cancer Likely to Return? Global Study Launches Preemptive Strike

Imagine you are looking at two boxes. Both contain weapons. One box reads, “To be used as a last resort only. Open if all else fails, and hope for the best.” The other says, “Open at the first sign of trouble. Strike early, strike hard, and set your sights on victory.”

Such is the transformation of chemotherapy for prostate cancer in recent years. Energized by scientists such as Mario Eisenberger —unsinkable, creative, stubborn, and above all, confident that they can find the winning formulas — the field has undergone nothing less than a revolution.

One key to the change is the philosophical evolution in chemotherapy’s role. Today’s drugs— many of them developed by Eisenberger and colleagues — are more targeted, with far fewer side effects than the devastating, “scorched earth” drugs of old. And this means that instead of being stuck on the sidelines — waiting to be needed in case the “A” team treatments (radical prostatectomy and radiation therapy) and “B” team treatments (hormonal therapy) were not successful — chemotherapy is getting into the game sooner than ever.

“Radical prostatectomy cures many men with prostate cancer,” says Eisenberger. “However, the disease comes back in about one-third of men, and many, unfortunately, will suffer from the symptoms caused by metastasis and die oftheir disease.” The good news is that instead of waiting for this to happen, “we now have many factors to help us predict which men are more likely to have cancer recur after surgery.”

These factors include:

  • The presence of tumor in the lymph nodesadjacent to the prostate
  • The presence of cancer in the seminal vesicles
  • The presence of cancer in the surgical margins
  • Gleason scores higher than 9, and
  • A very high PSA before surgery.

Success in other cancers: Doctors treating cancer of the breast and colon have found, i npatients at high risk of having a recurrence, that adjuvant treatment — starting chemotherapy and, in breast cancer, starting hormonal therapy as well, immediately after surgery — can delay

Adjuvant therapy:“The time has come for prostate cancer.”

the onset of metastasis and even prolong survival. “In fact,” notes Eisenberger, “in these two tumor types, if the surgical specimen shows that the adjacent lymph nodes are positive, the use of chemotherapy is standard.” In breast cancer, too, researchers have identified certain molecular markers that not only predict higher risk of recurrence, but have led to more specific ways of controlling the cancer.

“The time has come for prostate cancer,”says Eisenberger. He is heading a massive study to determine whether adjuvant treatment can delay the return of prostate cancer in menat high risk. This investigation, called the ATLAS study (Adjuvant Taxotere and Leuprolide Acetate Study), will involve more than 2,000 patients from more than 20 countries world-wide. It will test whether immediate hormonaltherapy using leuprolide acetate (which stops the production of testosterone) with or without taxotere, started right after surgery, works better than treatment with the same drugs given months or years later, when the cancer shows the first sign of recurrence (when thePSA starts climbing). “Taxotere is the best chemotherapy for prostate cancer that kills both cancer cells, which respond to testosterone,and those that do not respond to hormonal therapy,” says Eisenberger. Researchers in the ATLAS study also will collect patients’ tumor tissue and blood samples, in an attempt to discover, as in breast cancer, whether there are molecular markers to help define the biology of the cancer and even the design of new treatments.

 

 

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