Hormonal and radiation therapy for localized cancer

Goserelin + Flutamide + RT
Goserelin (Zoladex) 3.6 mg sc q4w 2 months before radiotherapy and then during radiotherapy
Flutamide (Eulexin) 250 mg po tid 2 months before radiotherapy and then during radiotherapy
Radiotherapy 70 Gy

Roach III M et al. Short-term neoadjuvant androgen deprivation therapy and external-beam radiotherapy for locally advanced prostate cancer: long-term results of RTOG 8610. J Clin Oncol 2008; 26:585 (link to the article).  

Pilepich, MV et al. Phase III radiation therapy oncology group (RTOG) trial 86-10 of androgen deprivation adjuvant to definitive radiotherapy in locally advanced carcinoma of the prostate. Int J Radiat Oncol Biol Phys 2001; 50:1243 (link to the article).

Goserelin + Flutamide + RT→Goserolin
Goserelin (Zoladex) 3.6 mg sc q4w 2 months before radiotherapy and then during radiotherapy
Flutamide (Eulexin) 250 mg po tid 2 months before radiotherapy and then during radiotherapy
Radiotherapy 70 Gy
After radiotherapy, continue  Goserelin (Zoladex) 3.6 mg sc q4w x 2 years

Horwitz EM et al. Ten-year follow-up of Radiation Therapy Oncology Group Protocol 92-02: a phase III trial of the duration of elective androgen deprivation in locally advanced prostate cancer. J Clin Oncol 2008; 26:2497 (link to the article). 

Hanks GE et al. Phase III trial of long-term adjuvant androgen deprivation after neoadjuvant hormonal cytoreduction and radiotherapy in locally advanced carcinoma of the prostate: The Radiation Therapy Oncology Group Protocol 92-02. J Clin Oncol 2003; 21:3972 (link to the article).
 

Chemotherapy and homonal therapy for PSA recurrence (back to top)

Docetaxel + Estramustine→Goserelin + Bicalutamide
Docetaxel (Taxotere) 70 mg/m2 iv over 1 h d2
Estramustine 280 mg po tid d1-5
Warfarin 1 mg po qd for prophylaxis of thrombosis
Q3w x 4 cycles
Followed by hormonal therapy starting on week 13:
Goserelin (Zoladex) 10.8 mg sc q3m x 15 months
Bicalutamide (Casodex) 50 mg po qd x 15 months

Taplin ME et al. Decetaxel, estramustine, and 15-month androgen deprivation for men with prostate-specific antigen progression after definitive local therapy for prostate cancer. J Clin Oncol 2006; 24:5408 (link to the article). 
  

Hormonal therapy for metastatic cancer (back to top)

Luprolide
Luprolide (Lupron) 7.5 mg im qm or 22.5 mg im q3m

Loblaw DA et al. Initial hormonal management of androgen-sensitive metastatic, recurrent, or progressive prostate cancer: 2006 update of an American Society of Clinical Oncology Practice Guideline. J Clin Oncol 2007; 25:1596 (link to the article).

Goserelin
Goserelin (Zoladex) 3.6 mg sc qm or 10.8 mg sc q3m

Loblaw DA et al. Initial hormonal management of androgen-sensitive metastatic, recurrent, or progressive prostate cancer: 2006 update of an American Society of Clinical Oncology Practice Guideline. J Clin Oncol 2007; 25:1596 (link to the article).

Bicalutamide
Bicalutamide (Casodex) 50 mg po qd

Loblaw DA et al. Initial hormonal management of androgen-sensitive metastatic, recurrent, or progressive prostate cancer: 2006 update of an American Society of Clinical Oncology Practice Guideline. J Clin Oncol 2007; 25:1596 (link to the article).

Flutamide 
Flutamide (Eulexin) 250 mg po tid

Loblaw DA et al. Initial hormonal management of androgen-sensitive metastatic, recurrent, or progressive prostate cancer: 2006 update of an American Society of Clinical Oncology Practice Guideline. J Clin Oncol 2007; 25:1596 (link to the article).

Ketoconazole + Hydrocortisone
Ketoconazole 400 mg po tid
Hydrocortisone 30 mg po qam, 10 mg po qpm

Small EJ et al. Antiandrogen withdrawl alone or in combination with ketoconazole in androgen-independent prostate cancer patients: a phase III trial (CALGB 9583). J Clin Oncol 2004; 22:1025 (link to the article).

Small EJ et al. Ketoconazole retains activity in advanced prostate cancer patients with progression despite flutamide withdrawl. J Urol 1997; 157:1204 (link to the article).

Trachtenberg, J. Ketoconazole therapy in advanced prostatic cancer. J Urol 1984; 132:61 (link to the article).

Prednisone
Prednisone 5 mg po bid

Tannock, I et al. Treatment of metastatic prostatic cancer with low-dose prednisone: evaluation of pain and quality of life as pragmatic indices of response. J Clin Oncol 1989; 7:590 (link to the article).

Dexamethosone
Dexamethasone (Decadron) 0.5-2 mg po qd

Nishimura, K et al. Low doses of oral dexamethasone for hormone-refractory prostate carcinoma. Cancer 2000; 89:2570 (link to the article).
 

Chemotherapy for metastatic cancer (back to top)

Docetaxel q3w + Prednisone
Docetaxel (Taxotere) 75 mg/m2 iv over 1 h q3w x 10 cycles
Prednisone 5 mg po bid

Berthold DR et al. Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer: updated survival in the TAX 327 study. J Clin Oncol 2008; 26:242 (link to the article). 

Tannock IF et al. Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. N Eng J Med 2004; 351:1502 (link to the article).

Docetaxel qw + Prednisone
Docetaxel (Taxotere) 30 mg/m2 iv over 30 min qw x 5 weeks every 6 weeks for 5 cycles
Prednisone 5 mg po bid

Berthold DR et al. Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer: updated survival in the TAX 327 study. J Clin Oncol 2008; 26:242 (link to the article).

Tannock IF et al. Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. N Eng J Med 2004; 351:1502 (link to the article).

Docetaxel + Estramustine
Estramustine 280 mg po tid d1-5
Docetaxel (Taxotere) 60 mg/m2 iv d2
Warfarin 2 mg po qd
Aspirin 325 mg po qd
Q3w x 12 cycles

Petrylak DP et al. Docetaxel and estramustine compared with mitoxantrone and prednisone for advanced refractory prostate cancer. N Eng J Med 2004; 351:1513 (link to the article).

Mitoxantrone + Prednisone
Mitoxantrone (Novantrone) 12 mg/m2 iv over 30 min q3w x 10 cycles
Prednisone 5 mg po bid

Tannock IF et al. Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer. N Eng J Med 2004; 351:1502 (link to the article).

Petrylak DP et al. Docetaxel and estramustine compared with mitoxantrone and prednisone for advanced refractory prostate cancer. N Eng J Med 2004; 351:1513 (link to the article). 

Estramustine + Vinblastine
Estramustine 600 mg/m2 po  qd x 6 weeks every 8 weeks
Vinblastine 4 mg/m2 iv qw x 6 weeks every 8 weeks

Hudes G et al. Improved survival for patients with hormonal-refractory prostate cancer receiving estramustine-based antimicrotubule therapy: final report of a Hoosier Oncology Group and Fox Chase Network phase III trial comparing vinblastine and vinblastine plus oral estramustine phosphate. 2002 ASCO annual meeting. Abstract 704 (link to the abstract). 

Hudes G et al. Vinblastine versus vinblastine plus oral estramustine phosphate for patients with hormonal-refractory prostate cancer: a Hoosier Oncology Group and Fox Chase Network phase III trial. J Clin Oncol 1999; 17:3160 (link to the article).   

Satraplatin + Prednisone
Satraplatin 80 mg/m2 po  qd d1-5 q5w
Prednisone 5 mg po bid

Sternberg CN et al. Satraplatin (S) demonstrates significant clinical benefits for the treatment of patients with HRPC: results of a randomized phase III trial. 2007 ASCO annual meeting. Abstract 5019 (link to the abstract). 

Estramustine + Cyclophosphamide
Estramustine 10 mg/kg po qd
Cyclophosphamide (Cytoxan) 2 mg/kg po qd
for 2 weeks every 4 weeks 

Bracarda S et al. Oral estramustine and cyclophosphamide in patients with metastatic hormone refractory prostate carcinoma: a phase II study. Cancer 2000; 88:1438 (link to the article). 

Cyclophosphamide
Cyclophosphamide (Cytoxan)
Regimen 1
50 mg/m2 po qd

 Lord R et al. Low dose metronomic oral cyclophosphamide for hormone resistant prostate cancer: a phase II study. J Urol 2007; 177:2136 (link to the article).

Regimen 2
100 mg/m2 po qd x 2 weeks every 4 weeks

Raghavan D et al. Oral cyclophosphamide for the management of hormone-refractory prostate cancer. Br J Urol 1993; 72:625 (link to the abstract).   

Vinblastine
Vinblastine 4 mg/m2 iv qw x 6 weeks every 8 weeks

Hudes G et al. Improved survival for patients with hormonal-refractory prostate cancer receiving estramustine-based antimicrotubule therapy: final report of a Hoosier Oncology Group and Fox Chase Network phase III trial comparing vinblastine and vinblastine plus oral estramustine phosphate. 2002 ASCO annual meeting. Abstract 704 (link to the abstract). 

Hudes G et al. Vinblastine versus vinblastine plus oral estramustine phosphate for patients with hormonal-refractory prostate cancer: a Hoosier Oncology Group and Fox Chase Network phase III trial. J Clin Oncol 1999; 17:3160 (link to the article).  

Vinorelbine
Vinorelbine (Navelbine) 30 mg/m2 iv d1 and 8 q3w

Morant R et al. Vinorelbine in androgen-independent metastatic prostate carcinoma-a phase II study. Eur J Cancer 2002; 38:1626 (link to the article).