In men with hormone refractory metastatic prostate cancer, single agents ha
ve demonstrated an objective response when using a response rate greater th
an standard treatment in prior National Prostate Cancer Project (NPCP) tria
ls. Among these agents are methotrexate, cisplatin, 5-fluorouracil, cycloph
osphamide, doxorubicin, estramustine, methyl N-(2-chloroethyl)-N'-cyclohexy
l-Nnitrosourea (CCNU), 5-(3,3-dimethyl-1-triazenyl)1 H-imidazole-4-carboxam
ide (DTIC), and vinblastine. Other combinations of protocols have been prev
iously evaluated.
Currently under review is a 14-year follow-up on an adjuvant trial (NPCP 90
0/1000) where all patients had a bilateral pelvic lymphadenectomy. These pa
tients were then randomized to surgery or radiation, and received either cy
clophosphamide, estramustine, or no therapy for 2 years. Clinical results s
howed there was no difference in disease-free survival or survival rates be
tween those patients in the group who had T3 prostate cancer, and those wit
h negative pelvic lymph node dissection.
The drugs diethylstilbestrol, megestrol, or streptozocin have been used. In
clinical trials, the single agent diethylstilbestrol usually had a better
effect. Combinations of estramustine with vinblastine were also effective w
hen compared with the results of standard treatment. When comparing patient
s who relapsed from hormone refractory prostate cancer, there was no signif
icant statistical response rate difference (P = < 0.05) in patients who wer
e offered either flutamide or estramustine.
To determine more accurately the positive results from these trials, the pr
e-prostate-specific antigen (PSA) era of stable disease must be re-evaluate
d. (C) 1999, Elsevier Science Inc.