Comparison of Hormonal Therapy and Chemohormonal Therapy in Patients with Newly Diagnosed Clinical Stage D Prostatic Cancer

Background: In order to examine the usefulness of chemohormonal therapy, we conducted a multicentered randomized trial comparing hormonal therapy, using a luteinizing hormone-releasing hormone (LH-RH) agonist, with chemohormonal therapy, hormonal therapy plus cyclophosphamide (CPM), in patients with newly diagnosed clinical stage D prostatic cancer.
Methods: Between January 1991 and March 1995, 41 evaluable patients with stage D prostatic cancer were randomized into 2 groups: group A (hormonal therapy alone), goserelin acetate depot 3.6mg subcutaneously every 4 weeks; group B (chemohormonal therapy), goserelin acetate depot 3.6mg subcutaneously and CPM 1000mg/m² intravenously every 4 weeks. The responses to the therapies were evaluated based on the criteria of The Japanese Urological Association.
Results: There were no significant differences between the 2 groups with regard to objective and subjective response rates. No advantage in chemohormonal therapy was observed in the survival rate and progression-free survival rate. However, the survival rate and progression-free survival rate of responders were significantly higher than those of nonresponders in both groups. When the results were categorized by histologic grade patients with poorly-differentiated adenocarcinoma had significantly higher response rates, survival rates, and disease-progression-free survival rates in Group B compared to similar patients in Group A.
Conclusions: We conclude that chemohormonal therapy does not definitely improve the clinical response and prognosis of patients with stage D prostatic cancer; however, for patients with poorly-ditferentiated adenocarcinoma, chemohormonal therapy is a useful treatment.