Chemo Hormonal Therapy and Surgery for Metastatic Prostate Cancer

Prostate cancer is the second leading cause of cancer-related deaths in the United States among men and the most commonly diagnosed cancer in American males. Most prostate cancer–related deaths are due to advanced forms of the disease.

A new study released in the journal, Nature, evaluated a newer approach to treating metastatic prostate cancer through Integrating chemo hormonal therapy and surgery. The method was applied to known or suspected lymph node metastatic prostate cancer.

Often, patient's with prostate cancer that keeps recurring or resisting therapies. Researchers had previously demonstrated molecular characteristics of deemed "lethal cancers" from the prostate after a prostatectomy was performed, presented with lymph node metastasis after chemohormonal treatment. 

Scientists monitored those patients treated with this hormone therapy after surgery and assessed whether a link exists between surgery and treatment-free/cancer-free survival.

What they found was quite astonishing.


What is Chemo Hormonal Therapy?

Chemo hormonal therapy or chemotherapy is a treatment used to cure, slow or ease symptoms of cancer. It works by using drugs to destroy cancer cells but it also destroys good cells, hence where most of the side effects come from such as hair loss. The use of hormone therapy to treat cancer is based on the observation that receptors for specific hormones that are needed for cell growth are on the surface of some tumor cells.

What is Metastatic Prostate Cancer?

Metastatic prostate cancer occurs when cancer cells break away from the original tumor in your prostate gland, spreading to other areas. Cancer cells can spread to others parts of the body as they travel through the blood, lymphatic system or other tissues. 

Prostate cancer in particular can metastasize anywhere in the body. However, most research points to malignant cells from the prostate more likely to spread to the bones in the hips, spine ad pelvis — areas very close to the prostate. 

After they've relocated, cancer cells begin to grow much faster. This new growth rate is still classified as prostate cancer be it originated in the prostate gland. 

The Study: Chemo and Surgery for Prostate Cancer

Researchers examined patients with clinically detected lymph node metastasis or primaries at high risk for nodal dissemination. Both groups were treated with androgen ablation and docetaxel therapies. Those responding with a PSA of less than 1 were recommend surgery treatment after 1 year from using ADT. After the surgery, ADT was withheld. The rate of survival without biochemical recurrence 1 year after surgery was measured to screen for efficacy. 

The results:

  • 40 patients were enrolled 
  • 39 was evaluable
  • 3 patients (7.7%) declined surgery
  • of remaining 36, 4 patients experience prostate cancer progression during treatment
  • 4 more did not reach PSA less than 1. 
  • 26 patients (67%) completed surgery
  • 13 (33%) saw no progression in their cancer 1 year post surgery
    • 8 had an undetectable PSA

27 months after the surgery was performed, 10 patients experienced the most frequent patters of first disease recurrence and 5 were systemic.

For the first time this suggests that integrating surgery may be superior to systehmic therapy alone for selected prostate cancer patients with nodal metastasis. Since half of the patients who underwent surgery were off treatment and progression-free 1 year following completion of all therapy.