Treatment of Advanced Prostate Carcinoma in Kyrgyzstan

Background and Aims: Human prostate cancer is a heterogeneous combination of androgen-dependent and androgen-independent cells, and then potential strategies for eradication of cell mixture have been focused on androgen ablation and radiation or cytotoxic drugs. This study explored the efficacy of two treatment protocols. Methods: A retrospective review was performed on a total 302 patients with distant metastases between 1986 and 1995 in Kyrgyzstan. This study includes 146 patients with systemically recurrent prostate cancer (group 1) and 156 patients with primary metastasized carcinoma (group 2). In each group the patients were treated by chemo-hormonal therapy or only by hormonal therapy. In Group 1 patients were treated with hormone deprivation alone by fosfestrol (n=68) and a combination of polychemotherapy and fosfestrol (n=78). In Group 2 only hormonal treatment had 62 (39.7 %) and a combined chemo-hormonal therapy had 94 (60.3%) patients. The patients were also grouped by the load of metastases, in low (< 5 metastases), intermediate (> 5 metastases confined to one organ or skeleton) and high (multiorgan metastasis). Results: A statistically significant prolonged survival in patients treated with chemo-hormonal therapy compared to the patients treated with hormonal therapy alone in both groups. In group 1 and 2 the median survival in the chemo-hormonal group was 24.5 and 25 months (p < 0.0001) versus 8 and 10.5 months in hormone group (p < 0.0001), respectively. Metastases distention did not change the significant disease specific survival advantage of the combined chemo-hormonal treatment in both groups. Conclusions: Chemo-hormonal therapy in recurrent metastasized and primary metastasized prostatic cancers significantly have prolonged overall and disease specific survival in comparison to hormonal therapy alone. Combined chemo-hormonal treatment should be started early in metastasized cancer, before the outgrow of hormone refractory tumor cell clones.