External Beam Radiation With or Without Chemotherapy to Treat High Risk Prostate Cancer

Phase 2/3 Study of Dose-escalated External Beam Radiation Therapy With or Without Chemotherapy for High Risk Adenocarcinoma of the Prostate

The purpose of this study is to compare the effects on prostate cancer using radiation therapy with or without chemotherapy.

The recommended treatment for a high risk prostate cancer consists of a combination of radiation therapy and androgen suppression for 2-3 years. Recent studies have shown a survival advantage for chemotherapy for prostate cancer. Chemotherapy has already been successfully integrated in the treatment of other cancer types and is our belief that chemotherapy will prove to be beneficial for patients with high risk prostate cancer. However, a clinical study is necessary to compare the results good or bad of chemotherapy with radiation therapy.

Inclusion Criteria:

• Histologically confirmed prostate adenocarcinoma (within 365 days of randomization.
• High-risk for recurrence as determined by evidence of at least one of the following: Gleason score 8-10, PSA > 20, T state T3.
• Histological evaluation of prostate biopsy with assignment of a Gleason score to the biopsy material: Gleason score must be in the range 2-10. > 6 cores are strongly recommended.
• Clinical stages T1a- T3 N0 M0 as staged by the treating investigator. (AJCC Criteria 7th Ed.-appendix III).
• PSA values < = 50 ng/ml within 90 days prior to randomization. Must be completed prior to biopsy or at least 21 days after prostate biopsy.
• Absolute Neutrophil Count (ANC) > = 1,800 cells/mm³ within 90 days prior to randomization.
• Platelets > = 100,000 cells/mm³ within 90 days prior to randomization.
• Hemoglobin > 10 g/dl within 90 days prior to randomization.
• ALT, AST, and total bilirubin within 1.5 X institutional upper normal limits within 90 days prior to randomization.
• ECOG status 0-1 (appendix II) documented within 90 days of randomization.
• Patient must sign study specific informed consent prior to randomization. Note: consent for legally authorized representative is not permitted.
• Completed all requirements listed in section 4.0 within the specified time frames.
• Able to start treatment within 56 days of randomization.
• At least 18 years old and less than or equal to 75 years of age.
• Men of child-producing potential must be willing to consent to use effective contraception while on treatment and for at least 3 months afterwards.
• Medical oncology consultation prior to randomization and medically approved for chemotherapy treatment per protocol.

Exclusion Criteria:

• Evidence of distant metastasis.
• Pelvic lymph nodes > 1.5 cm in greatest dimension unless the enlarged lymph node is biopsied and negative.
• Prior prostate cancer surgery including but not limited to prostatectomy, hyperthermia and cryosurgery.
• Prior pelvic radiation for their prostate cancer.
• Prior androgen deprivation.
• Severe, active co-morbidity, defined as follows:
• Active rectal diverticulitis, Crohn's disease affecting the rectum or ulcerative colitis. (Non-active diverticulitis and Crohn's disease not affecting the rectum are allowed).
• Unstable angina and/or congestive heart failure requiring hospitalization within the last 6 months.
• Myocardial infarction within the last 6 months.
• Acute bacterial or fungal infection requiring intravenous antibiotics at the time of randomization.
• Acquired Immune Deficiency Syndrome (AIDS) based upon current CDC definition; note, however, that HIV testing is not required for entry into this protocol. The need to exclude patients with AIDS from this protocol is necessary because the treatments involved in this protocol may be significantly immunosuppressive.
• Prior allergic reaction to the drugs involved in this protocol.
• Existing peripheral neuropathy > = grade 2.
• Prior systemic chemotherapy for prostate cancer.
• History of proximal urethral stricture requiring dilatation.
• Major medical, addictive or psychiatric illness which in the investigator's opinion, will prevent the consent process, completion of the treatment and/or interfere with follow-up.
• Evidence of any other cancer within the past 5 years and < 50% probability of a 5 year survival. (Prior or concurrent diagnosis of basal cell or non-invasive squamous cell cancer of the skin is allowed.)