A Conversation on the Role of Chemotherapy in mHSPCa Patients

An interview by E. David Crawford, MD with Neal Shore, MD discussing the role of early chemotherapy use in the treatment of metastatic hormone-sensitive men with prostate cancer.

Neal Shore discusses the implications of CHAARTED and more recently STAMPEDE results that provide evidence supporting aggressively treating metastatic hormone-sensitive prostate cancer with docetaxel added to androgen deprivation therapy to improve overall survival.  

In June 2014 at the ASCO Annual meeting, the lead author Christopher J. Sweeney, MBBS, medical oncologist at the Lank Center of Genitourinary Oncology at the Dana-Farber Cancer Institute in Boston, presented the results from the CHAARTED study where patients were randomized to compare chemotherapy plus androgen deprivation therapy (ADT) versus ADT alone in men with metastatic prostate cancer. A planned interim analysis dramatically met the criteria for overall survival significance. Median OS was 57.6 months in the ADT plus docetaxel arm and 44.0 months in the ADT arm (HR 0.61,95% CI:0.47,0.80;P=0.0003).  At the 2015 ASCO Annual meeting the UK-led STAMPEDE data were presented by STAMPEDE Chief Investigator, Professor Nick James.  The STAMPEDE results demonstrate that adding docetaxel chemotherapy to standard hormone therapy markedly improved survival for men with newly diagnosed advanced prostate cancer not previously treated with hormone therapy (hormone-naive). Men who received docetaxel plus standard therapy lived on average 10 months longer than those who received only standard therapy.

in the United States newly diagnosed patients with prostate cancer presenting with radiological confirmed metastatic disease is estimated to be about 4% to 5%, of all newly diagnosed men with prostate cancer, so the impact of these data represents a small subset of the annual newly diagnosed patient population.  However treatment of the castration-resistant prostate cancer (CRPC) patient has evolved rapidly over the past five years and the urologists are a critical member of the multidisciplinary team engaged in diagnosing and treating all of these patients.  In this conversation Neal Shore and E. David Crawford provide treatment considerations of the metastatic hormone-sensitive prostate cancer patients.    

Biography - Neal Shore, MD. FACS

Neal D. Shore, MD, FACS, is the Medical Director of the Carolina Urologic Research Center. He practices with Atlantic Urology Clinics in Myrtle Beach, South Carolina. Dr. Shore has conducted more than 100 clinical trials, focusing mainly on prostate and bladder disease.

Dr. Shore is a Certified Physician Investigator who has numerous publications in peer-reviewed journals and has lectured extensively on the treatment of prostate cancer and prostate enlargement. He serves on several industry advisory boards as well as academic and advocacy networks: including the Society Urologic Oncology Clinical Trials Consortium, Bladder Cancer Advocacy Network, Large Urology Group Practice Association, and NCI GU Science Steering Committee. Dr. Shore attended Duke University,’80 and Duke Medical School,’84, Durham, North Carolina. He performed a six-month clinical research fellowship in Pretoria, South Africa, and then completed his General Surgery/Urology training at New York Hospital Cornell Medical Center/Memorial Sloan-Kettering Cancer Center in New York City in 1990. He is the managing partner for Atlantic Urology Clinics, where he has participated in a full-time clinical practice for the past 18 years.

Biography - E. David Crawford, MD. 

E. David Crawford is an internationally recognized urologist and is the distinguished endowed professor of surgery, urology, and radiation oncology, and head of the Section of Urologic Oncology at the University of Colorado Anschutz Medical Campus in Aurora, Colorado. He also serves as the practice director for the urologic oncology clinic. His areas of expertise include benign prostate hypertrophy, urologic cancers, and in particular, prostate cancer.

Dr. Crawford received his medical degree from the University of Cincinnati. His postgraduate training included an internship and residency in urology at the Good Samaritan Hospital in Cincinnati. He subsequently completed a genitourinary cancer fellowship, at the University of California Medical Center, in Los Angeles.

The recipient of more than 95 research grants, he has conducted research in the treatment of advanced bladder cancer, metastatic adenocarcinoma of the prostate, hormone refractory prostate cancer, and other areas of urological infections and malignancies. He has authored or coauthored over 450 articles that have been published in such journals as Urology, the New England Journal of Medicine, the Journal of Urology, and the Journal of the National Cancer Institute. 

He has published five textbooks and authored over 50 book chapters, and is an editorial reviewer or consultant for a large number of publications, includ