Is there a case for early chemo in patients with metastatic prostate cancer?

This is a game changing study that deserved to be published in the New England Journal of Medicine. Up until recently chemotherapy for prostate cancer patients was saved as an ostensibly palliative treatment for advanced patients, for whom ADT was no longer effective. The use of chemo as a treatment of last resort made sense since it wasn’t curative, carried substantial side effect burden, and did little to extend life.

However, the authors of this study, which involved 790 patients randomized to receive either ADT alone or early chemotherapy along with the ADT, showed that the combined treatment added more than a year to the overall survival of the patients, for whom ADT was still effective. We are already beginning to see patients at our major cancer centers in Western Canada (where the authors of this blog are based) on this combined therapy. From a quality-of-life perspective, we suspect that managing the concurrent side effects of chemotherapy and ADT will be challenging for some patients, but we are optimistic that the combined treatment will be beneficial in the long run.


Sweeney CJ, Chen YH, Carducci M, Liu G, Jarrard DF, Eisenberger M, Wong YN, Hahn N, Kohli M, Cooney MM, Dreicer R, Vogelzang NJ, Picus J, Shevrin D, Hussain M, Garcia JA, DiPaola RS. 2015. Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer. N Engl J Med 373(8):737-746.