Chemotherapy in early stage of hormone-resistant metastatic prostate cancer: what are the indications?

Treatment of hormone-refractory prostate cancer remains a source of debate. Since 2004, docétaxel-based chemotherapy has become the standard treatment as it has demonstrated efficacy on overall survival in two randomized studies. In some studies, chemotherapy seems to be also effective on pain relief. The adverse effects occur more frequently than with others chemotherapy (mitoxantrone) but are moderated and aren't responsible of specific mortality. These facts encourage to begin the chemotherapy as earlier as possible even before metastases appear. Some studies have even raised the issue of an initiation of chemotherapy before the onset of hormone independence. However these arguments might be use with caution. The treated patients have a limited life expectancy and a 2 months gain of survival may be of limited value. Furthermore, even low side effects can generate a morbidity on these fragile patients especially when they are initially asymptomatic. Thus, an early initiation of chemotherapy must be discussed case by case, on an individual basis. The prognosis factors and alternative therapeutic options based on new molecules used in metastatic cancer might also be considered for the therapeutic decision.