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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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