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Prostate cancer is the second most common cancer in men. In the United States, it is estimated that there will be 233,000 cases in 2014 with nearly 29,500 succumbing to this disease. Prostate specific antigen or PSA is a blood test that has been widely used to detect prostate cancer in men. Following the introduction of this test, the incidence of prostate cancer peaked in 1992 with a subsequent decline between 1992 through 1995 and since that time it has risen at the rate of about 1% per year. There has been some controversy about the PSA in the last few years.
After men are diagnosed with prostate cancer, they typically undergo a staging process to find out whether they belong in stage I, stage II, stage III or stage IV disease. Patients with stage IV disease are referred to as metastatic prostate cancer. In this group of patients, cancer cells travel to other parts of the body ie lungs, bone, brain etc. Initial therapy for this group of patients has historically been the use of androgen deprivation (ADT) and responses can last for several months. However, in many patients, cancer cells outsmart the hormonal therapy and PSA starts to rise and trouble starts all over again. Chemotherapy has never been used upfront in stage IV prostate cancer patients until now.
At the recently concluded ASCO meeting in Chicago in June 2014, results of a clinical trial ( Chemohormonal Therapy versus Androgen Ablation Randomized Trial for Extensive Disease in Prostate Cancer (CHAARTED) were reported and that generated a lot of excitement amongst the oncology community. Overall survival in metastatic prostate cancer improved by more than a year when patients received chemotherapy with docetaxel (given every three weeks for six treatments) along with androgen deprivation therapy (ADT). This trial ended prematurely after an interim analysis revealed a statistically significant survival difference between the 2 treatment groups. Androgen depravation therapy consists of an injection with LHRH antagonist or surgical castration. Physiologic purpose is to potentially eliminate the function of the male hormone testosterone. In this clinical trial, men who were randomized to androgen deprivation therapy plus chemotherapy using docetaxel had a median overall survival of 57.6 months versus 44 months for men who received androgen deprivation therapy alone. This represented a major milestone in the treatment for prostate cancer patients . the advantages of this magnitude have not previously been seen in this disease and this was the reason that it created tremendous amount of excitement within the oncology community .
Dr.Christopher Sweeney of the Dana-Farber cancer Institute in Boston reported the results at the American Society of clinical oncology annual meeting in Chicago. According to him, this represented one of the biggest improvements in survival in a clinical trial in any metastatic solid tumor. Several experts in the field of prostate cancer management and revealed that excitement about this “home run” in prostate cancer. In prostate cancer research, scientists and medical oncologists have had several singe and double hits in baseball parlance, but, this major improvement in survival stands out as a significant advance in this field.
ASCO president Clifford Hudis also praised the results of this landmark trial when he mentioned – “In prostate cancer, I am not aware of any historical study that ever offered up this magnitude of improvement in survival. Quite frankly, across all of the solid tumors, this is an almost unprecedented improvement in median survival.”
Dr. Nilesh D. Mehta