Abstract
Background and Aims: We compared two treatment methods on patients with advanced prostatic carcinoma in two treatments groups: primary metastatic prostatic carcinoma and metastasized recurrent tumor after primary treatment.
Methods: A retrospective review was performed on a total 302 patients with distant metastases between 1986 and 1995: 146 patients with systemically recurrent prostate cancer (group 1) and 156 patients with primary metastasized carcinoma (group 2). In each group the patients were treated by chemo-hormonal therapy or only by hormonal therapy. In Group 1 patients were treated with hormone deprivation alone by fosfestrol (n=68) and a combination of polychemotherapy and fosfestrol (n=78). In Group 2 only hormonal treatment had 62 (39.7 %) and a combined chemo-hormonal therapy had 94 (60.3%) patients. The patients were also grouped by the load of metastases, in low (< 5 metastases), intermediate (> 5 metastases confined to one organ or skelet) and high (multiorgan metastasis).
Results: A statistically significant prolonged survival was found in Group 1 patients treated with chemo-hormonal therapy compared to the patients treated with hormonal therapy alone. The median survival in the chemo-hormonal group was 24.5 months compared to 8 months in hormone group (p < 0.0001). The amount of metastases did not change the significant disease specific survival advantage of the combined chemo-hormonal treatment. The same significant survival advantage was demonstrated in Group 2 for the combination treatment compared to estrogen treatment alone. The median overall survival in the chemo-hormonal group was 25 months, compared to the 10.5 months for the patients treated with hormone ablation alone (p < 0.0001). This difference was also maintained after stratification for tumor grade or metastasis load.
Conclusions: Chemo-hormonal therapy significantly prolonged overall and disease specific survival over hormonal therapy alone in recurrent metastasized and primary metastasized cancers. Combined chemo-hormonal treatment should be started early in metastasized cancer, before the outgrow of hormone refractory tumor cell clones.
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