Early use of chemotherapy in conjunction with radical prostatectomy.

Since the advent of prostate-specific antigen testing, most prostate cancers are now detected in an early, organ-confined stage. Because of this, local therapies including radical prostatectomy and irradiation have become more common in the treatment of men with prostate cancer. Nonetheless, relapse of disease remains a major problem. In the past decade, many groups have studied the early use of chemotherapy with or without hormonal therapy after radical prostatectomy, specifically, and found it to be safe. In this article, we will summarize the data for neoadjuvant and adjuvant chemotherapy and chemohormonal therapy in conjunction with radical prostatectomy. We will also highlight more recent clinical trial designs, including a multicenter pilot study of adjuvant docetaxel therapy, which has several important distinctions when compared with previous studies, including the active chemotherapeutic agent docetaxel, better risk-adapted patient accrual, and higher statistical power. Although data for this study are not yet mature, these differences in clinical trial design make such studies in adjuvant chemotherapy for patients with high-risk prostate cancer novel and promising.