What is the effect of combined chemotherapy in early stage of metastatic prostate cancer?

What is metastatic prostate cancer?

Prostate cancer is a common cancer in older men and the most common cancer in European and American men. In my country, the incidence rate is also increasing year by year as the population ages and the dietary structure changes. Prostate cancer usually has an insidious onset and progresses slowly, but bone metastasis often occurs when it is discovered, which is clinically called metastatic prostate cancer. Metastatic prostate cancer is currently mainly treated with drug castration. This is because the proliferation of prostate cancer cells usually depends on androgens. After treatment with drugs that reduce androgen levels or drugs that counteract the effects of androgens, prostate cancer cells will undergo apoptosis.

What is castration-resistant prostate cancer?

However, most prostate cancer patients will progress to castration-resistant prostate cancer after 2 to 3 years of castration treatment. At this time, despite the continued use of castration drugs, the patient's PSA level will continue to increase progressively, and clinical progression symptoms such as dysuria, hematuria, bone pain, and even paraplegia will appear.

After castration resistance occurs, the current common treatment is to use docetaxel chemotherapy combined with castration therapy. This regimen can extend the survival time of most patients by about 5 months, while alleviating symptoms such as bone pain and dysuria. There are currently several new drugs that can be used to treat castration-resistant prostate cancer, such as abiraterone, but these new drugs have not yet been approved for marketing in my country, are expensive, and can only extend survival time by 5 to 7 months.

Why early combination chemotherapy?

The so-called "early" combination chemotherapy refers to the use of combination chemotherapy to treat metastatic prostate cancer as early as possible before castration resistance occurs. A research report published in the New England Journal of Medicine in August 2015 pointed out that the use of combination chemotherapy before castration resistance occurs can extend the overall survival time by 13.6 months compared with the use of castration therapy alone, and the time of castration resistance is delayed by about 10 months. This result was obtained in a clinical controlled trial involving 790 patients over a period of 9 years. It should be quite credible.

Are there any side effects of chemotherapy?

It should be said that docetaxel monotherapy has much fewer side effects than classic combination chemotherapy, and generally speaking, the benefits outweigh the risks. In particular, chemotherapy is much safer when performed in the early stage when the patient's physical condition is still good than when the body is weakened after the disease progresses. In the above study, about 2% of patients had allergic reactions, 4% had fatigue reactions, less than 1% of patients had diarrhea, stomatitis, motor neuron disease and sensory neuron disease, about 1% of patients had thromboembolism, and about 6% of patients had neutropenic fever. Nearly 90% of patients successfully completed 6 cycles of chemotherapy.

How much does chemotherapy cost?

At present, our department uses imported docetaxel for chemotherapy, and adjusts the drug dosage according to the patient's weight and response. The cost of one cycle of chemotherapy is about 10,000 yuan, and a total of 6 cycles are carried out, with a total cost of about 60,000 to 70,000 yuan. Shenzhen Social Security can reimburse most of the costs in proportion.

Do I need to stay in the hospital during chemotherapy?

No. Each chemotherapy session requires about 3 to 4 days of hospitalization, and the interval between chemotherapy sessions is usually 3 weeks. During this period, patients can go home to recuperate. However, they need to pay attention to rest, avoid crowded places, and return to the hospital for follow-up visits in a timely manner if they feel any discomfort.