Aggressive Combination of Drug Treatment, Local Therapy Shows Promise as Cure for Metastatic Prostate Cancer

A new study revealed that aggressive combination of systemic and local therapies can potentially cure patients with metastatic prostate cancer.

The study, published in the journal Urology, showed that patients treated with the combination of drug treatment, surgery and radiation showed signs of improvements, with no detectable disease and prostate-specific-androgen (PSA) and normal blood testosterone.

"The sequential use of the three different modalities helped illustrate the role and importance of each in achieving the undetectable PSA with normal testosterone level end point, which represents a 'no-evidence of disease' status," said Howard I. Scher, MD, Chief of the Genitourinary Oncology Service at Memorial Sloan Kettering Cancer Center in New York City and lead investigator of the study, in a press release.

For the study, the researchers recruited 20 patients with metastatic prostate cancer. Out of those, five have extrapelvic lymph nodal disease and 15 have bone disease. All patients were treated with androgen deprivation therapy (ADT), radical surgery and radiation therapy. The radical surgery included a retroperitoneal lymph node dissection and was performed as needed. On the other hand, the radiation therapy was done to visible metastatic lesions in the bone. If a patient present undetectable PSA after combined modality therapy for a minimum of six months, the researchers ceased the use of ADT.

Among the 15 patients with bone metastases, 14 of them reached undetectable PSA using the combination of ADT, surgery and radiation. On the other hand, four of the five patients with extrapelvic lymph nodal disease reached undetectable PSA after ADT and surgery. The remaining patient with extrapelvic lymph nodal disease needed radiation to reach undetectable PSA.

Despite being in the initial stages, the combined treatment regimen was well tolerated by the patients. The next step for the researchers is to conduct a Phase 2 trial to determine the efficacy of the combined modality approach and test if the endpoint, a PSA of <.05 ng/mL and serum testosterone of >150 ng/dL at 20 months after the start of ADT, can really be used as an indicator that a patient with metastatic prostate cancer is cured.