An overview of chemotherapy trials in localized and recurrent nonmetastatic prostate cancer

Purpose: High risk localized and recurrent prostate cancers remain difficult problems for clinicians. Definitive local treatments such as surgery and radiation therapy cure only a minority of these patients. As a result, efforts are being made to decrease the risk of recurrence and delay progression to symptomatic hormone refractory disease using chemotherapy prior to, during or after definitive local therapy. Materials and Methods: A MEDLINE literature review was performed of studies evaluating chemotherapy and other systemic therapies for localized prostate cancer. In addition, ongoing randomized clinical trials were reviewed. Results: Chemotherapy in the management of localized and recurrent disease is evolving. Early studies demonstrated the feasibility of administering chemotherapy to patients prior to and immediately after local therapy, and in the setting of an increasing prostate specific antigen state. Although chemotherapy has established activity and acceptable toxicity in patients with hormone refractory prostate cancer, more extensive use in patients with androgen dependent disease will require data from randomized studies to determine its efficacy. At least 5 ongoing, randomized, phase III trials currently are evaluating the role of chemotherapy in various prostate cancer disease states, including nonmetastatic, hormone refractory disease, the increasing prostate specific antigen state, and adjuvant and neoadjuvant settings in patients at high risk. Conclusions: Chemotherapy is being investigated actively in randomized trials of earlier states of prostate cancer. Enrollment onto clinical trials should be the highest priority for investigators and clinicians.