Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Aug 10, 2015; 6(4): 35-42
Published online Aug 10, 2015. doi: 10.5306/wjco.v6.i4.35
Concurrent chemoradiation for high-risk prostate cancer
Benjamin T Cooper, Nicholas J Sanfilippo
Benjamin T Cooper, Nicholas J Sanfilippo, Department of Radiation Oncology, New York University School of Medicine, New York, NY 10016, United States
Author contributions: Cooper BT and Sanfilippo NJ wrote this paper.
Conflict-of-interest statement: The authors have no real or potential conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Nicholas Sanfilippo, MD, Department of Radiation Oncology, New York University School of Medicine, 160 East 34th Street, New York, NY 10016, United States.
Telephone: +1-212-7315003 Fax: +1-212-7315517
Received: March 26, 2015
Peer-review started: March 28, 2015
First decision: April 27, 2015
Revised: May 6, 2015
Accepted: July 7, 2015
Article in press: July 8, 2015
Published online: August 10, 2015

There are estimated to be 220800 cases of prostate cancer diagnosed in 2015, making up 26% of all cancer diagnoses. Fortunately, adenocarcinoma of the prostate is often a highly treatable malignancy. Even though the majority of prostate cancer patients present with localized disease, prostate cancer still accounts for over 27000 deaths a year. There is a subset of patients that are likely to recur after locoregional treatment that is thought of as a “high-risk” population. This more aggressive subset includes patients with clinical stage greater than T2b, Gleason score greater than 7, and prostate specific antigen greater than 20 ng/dL. The rate of biochemical relapse in this high risk group is 32%-70% within five years of definitive focal therapy. Given these discouraging outcomes, attempts have been made to improve cure rates by radiation dose escalation, addition of androgen depravation therapy, and addition of chemotherapy either sequentially or concurrently with radiation. One method that has been shown to improve clinical outcomes is the addition of chemotherapy to radiotherapy for definitive treatment. Concurrent chemoradiation with 5-fluorouracil, estramustine phosphate, vincristine, docetaxel, and paclitaxel has been studied in the phase I and/or II setting. These trials have identified the maximum tolerated dose of chemotherapy and radiation that can be safely delivered concurrently and established the safety and feasibility of this technique. This review will focus on the addition of concurrent chemotherapy to radiotherapy in the definitive management of high-risk prostate cancer.

Keywords: Prostate cancer, Chemoradiation, High-risk prostate cancer, Concurrent chemotherapy, Chemotherapy, Intensity modulated radiation therapy

Core tip: Over half of patients with high-risk prostate cancer will have a biochemical relapse within 5 years when treated primarily with radiotherapy as shown in multiple studies. One method that has been shown to improve local control, and in some disease sites overall survival, is the addition of chemotherapy to radiotherapy for definitive treatment. We review the safety and efficacy data of combined chemoradiation in patients with high risk adenocarcinoma of the prostate.