Good question. It is one that I asked last year. My answer is as follows:
The problem with certain combinations of chemotherapy lies not in that it
kills cancer cells (they have known that for twenty years) it does;
unfortunately, it kills people also. Most of the research has been to
determine what doses and what combinations work the best. FDA is primarily
concerned about what is safe and not harmful (kills) people. Most of what is
approved by the FDA only extends life,depending on Gleason grade and the
extent of involvement, a very short time.

I am working with a research specialist who is having 30% success rate with
a re-growth of bone to damage areas (bone mets). Even with that, the best he
can do is add ten years. It simply is a waiting game.

With that said, a co-worker was diagnosed two months before me with a
Gleason 9 (5+4), His immediate treatment was Hormones, RP, following by
Chemo with Radiation at the same time. He was treated in a major medical
reasearch environment.

I on the other hand with a Gleason (4+3) was treated initally with seeds and
IMRT. PSA never went down and within a year showed two not spots on my spine
and started hormones with chemo in a Phase II trial at a major medical
research facility next door to my co-worker.

Who is better off? I simply do not know and I suspect the medical community
does not either.

wait for the nasty mutations to develop.

been proven  effective against either localized or advanced PCa.

Depending on the PSA, Gleason and Stage, it may not be necessary to
introduce the toxicity of chemo into the regimen.

RRP can cure.  RT, it is said, can cure.  HT, though it can cure, does so
rarely that it is not considered as such.  Chemo does not cure.

PCa works so slowly, that different treatments can be tried and they can be
tried years apart.

Next, RRP carries with it temporary incontinence and impotence.  So does RT
and, in the future, it can produce longer lasting SEs including permanent
incontinence and impotence.  HT causes greater impotence and a myriad of
other SEs.  Chemo is extremely toxic and generally is said to kill the
cancer and barely comes up short of killing the host.

That is now and certainly was then.  In the future, who knows?

wait for the nasty mutations to develop.

rather than wait for the nasty mutations to develop.

I think it all depends on the nature of your PCa such as:

PSA at time of diagnosis
Gleason score - sum & total.
Staging.
Determination, to the extent possible, regarding extracapsular
extension.
DNA Ploidy analysis
Number of biopsy specimens positive for cancer
% of each core with cancer

Chemotherapy does add chemicals to your body that are not particularly
pleasant with noticeable side effects and it is expensive.  Also, while
there is some optimism and some results that indicate a positive
result, it is a bit early to tell the long term benefit - such as does
chemotherapy result in longevity of life for people with PCa. So unless
very good medical advice indicates it is warranted early in the PCa
treatment process it would probably be best not to include chemotherapy
as a "routine" treatment.

That all said I did have chemotherapy 7 months after after beginning
ADT3 (aka HT).

My history:

PSA 3.8
Gleason 4+4 = 8
Stage T3a
Biopsy indicated perineural invasion was present.
DNA Ploidy was diploid
5 of 9 biopsy cores positive for PCa
% cancer in the 5 specimens - 50, 70, 80, 90, 100%

Started on ADT3 (Casodex, Proscar, Lupron)
PSA at that point was 3.8

7 months later started chemotherapy (50mg.Taxotere intravenously once a
week for 12 weeks.
PSA at that point was 0.067.

3 months later concluded chemotherapy
PSA at that point was 0.025

When medical oncologist suggested chemotherapy he said it was
"experimental" and he could not predict what full effect it may have on
my PCa.  He said I had a high grade aggressive type of PCa and there
existed the possibility of micro metatastic disease although that could
not be determined a given fact.  Maybe yes or maybe know but better to
assume yes and treat accordingly.  He said aggressive PCa needed
aggessive treatment and chemotherapy was "aggressive".  I was made
aware of possible side effects.  I was made aware the effectiveness of
chemotherapy on PCa was unclear.  The idea was to treat me aggressively
rather than wait around a few years to determine the results of
chemotherapy over the long run.

After being off chemotherapy for 3 months (to recover) I then started
43 weeks of Intensity Modulated Radiation Therapy (IMRT) augmented by
B-mode aquistioning and targeting (BAT).  This was 4680 rads to the
pelvic lymph  nodes and prostate followed by 3060 rads to the prostate
alone.
PSA at the start of IMRT / Bat was 0.025.
PSA at end of IMRT / BAT was 0.009

ADT3 was continued throughout the time I was doing chemotherapy and
IMRT / BAT.

ADT3 was discontinued 21 months ago - 4 months after completing IMRT /
BAT

Apr 2003...PSA...0.004
Jul 2003...PSA...0.003
Nov 2003...PSA...0.030
Feb 2004...PSA...0.050
May 2004...PSA...0.060
Aug 2004...PSA...0.060
Nov 2004...PSA...0.070
Feb 2005...not yet done

My medical oncologists "think" increase in PSA is due to the fact that
I still have a prostate and that testosterone has returned to near same
level as when ADT3 was intiated.

Medical oncologists think I am doing "fine" as does radiation
oncologist.  However, as we all know, this is somewhat of a guess and
time will tell what is really going on.  However - as they also say -
think positive, reduce stress.

In any event, Mike, I included all of the above just to give you a case
history of someone who did start chemotherapy not too long after ADT3
was initiated along with some reasons related to my case on why I
elected to do so.

Everyone's PCa is unique to themselves and what treatment one person
decides on may not be at all the same as someone else.

Regards,

Harold

As I understand it traditional chemo works w/ other cancers because it
targets the fast-growing cells that characterize those forms of cancer.
That is also why patients lose their hair - because it is fast growing.
However, PCa is NOT fast-growing so proven agents haven't been shown
to be very effective, certainly not curative.

Bill Denton
RP 2/12/02
PSA .45
Memphis