Prostate cancer at the 2007 ASCO meeting: an urologist's perspective.

During the last ASCO meeting in Chicago, multiple presentations focused on prostate cancer. Several prognostic factors have been developed, either at the initial stage or early during treatment. At the localized stage, the change in prostate volume, evaluated using MRI after 2 months of hormone therapy, is a strong predictor of recurrence following the combination of radiotherapy with hormone therapy. At the metastatic hormone-refractory stage, the initial number of circulating tumour cells is of interest. Early change during chemotherapy is a strong predictor of efficacy and survival. In these patients, survival is predicted by the initial level of PSA and the time in which it doubles. The biological response is not associated with the overall survival, and therefore should not be considered as a reliable surrogate marker, leading to a new definition of response criteria for phase II trials. The EORTC trial 22961 clearly demonstrated that prolonged hormone therapy combined with radiotherapy is better than a few months of hormone therapy in locally advanced disease. This was also shown in a reanalysis of the RTOG 8531 trial. Results from prospective randomized trials on intermittent hormone treatment are growing, with a randomized trial in patients with locally advanced or metastatic disease and with a median follow up of more than 50 months. The definition of hormone-refractory status should be reconsidered with the development of new hormonal blockers. The use of Docetaxel is changing, with increasing experimental use at earlier stages. Although Atrasentan did not achieve its objectives, Satraplatin (an oral platinum salt) seems to be of interest in second line chemotherapy in a large phase 3 trial of more than 900 patients with hormone-refractory metastases.