Chemotherapy in Non-metastatic Prostate Cancer – Can we justify it?

David Eedes shares his thoughts on two recent articles in the January JAMA debating the use of chemotherapy in the treatment of non-metastatic prostate cancer. 

The CHAARTED and STAMPEDE trials showed that using chemotherapy earlier in the treatment pathway offers benefits to subsets of patients with metastatic prostate cancer.

This has led to questions (and a few authorisation requests in ICON) about using chemotherapy in the non-metastatic setting, especially in those patients with biochemical recurrence or very high-risk features.

These two opinion pieces in the January 2017 JAMA which argue opposite points of view are thought-provoking and worth looking at, I believe:

  1. Avoiding Under treatment of Aggressive Prostate Cancer by Early Use of Chemotherapy by Evan Y. Yu, MD; Daniel W. Lin, MD:
  2. Should Chemotherapy Be Used in Non-metastatic Prostate Cancer? By Julie N. Graff, MD; Joshi J. Alumkal, MD; Tomasz M. Beer, MD:

Advances in risk stratification, detection of micro-metastatic disease and the maturing data from these two trials will, possibly, give us further insights. The hope is that further trials will be designed to more clearly define the role of earlier treatment.

As clinicians, our wish is to improve our patients’ outcomes. Currently, metastatic prostate cancer is incurable. For these reasons, any move to find curative options for at-risk prostate cancer patients rather than waiting for metastatic disease is good news.

Your comments and feedback are always welcome.