Combination Chemotherapy Followed by Surgery in Treating Patients With Localized Prostate Cancer

OBJECTIVES:

• Determine the 5-year freedom from prostate-specific antigen (PSA) recurrence in patients treated with this regimen.
• Define the maximum tolerated dose of neoadjuvant docetaxel and mitoxantrone followed by prostatectomy in patients with high-risk localized prostate cancer. (Phase I completed as of 2/15/02)
• Determine the toxicity of this regimen in these patients.
• Determine the PSA response rate and pathologic response rate in patients treated with this regimen.
• Determine the clinical response in patients treated with this regimen.
• Determine the overall survival of patients treated with this regimen.
• Determine the surgical margin status at time of prostatectomy in patients treated with this regimen.

OUTLINE: This is a dose-escalation study of mitoxantrone. (Phase I completed as of 2/15/02)

Patients receive neoadjuvant docetaxel and mitoxantrone weekly on weeks 1-3. Treatment repeats once a week for a total of 4 courses.

Patients receive escalating doses of mitoxantrone until the maximum tolerated dose is determined. (Phase I completed as of 2/15/02)

Patients undergo prostatectomy 2-4 weeks after completion of neoadjuvant chemotherapy.

PROJECTED ACCRUAL: A total of 60 patients will be accrued for this study.

DISEASE CHARACTERISTICS:

• Histologically confirmed adenocarcinoma of the prostate

• High-risk, as defined by 1 of the following:

• Stage T2b (palpable bilateral involvement) or surgically resectable T3
• PSA 15 ng/mL or greater
• Gleason grade greater than 4+3 (4+3, 4+4, or 5+any, but not 3+4)
• At least a 50% chance of prostate cancer recurrence within 5 years
• Planned prostatectomy as primary therapy
• No evidence of bone metastases by bone scan
• No evidence of lymph nodes greater than 2 cm on pelvic computed tomography (CT) scan (scan required only if PSA greater than 40 ng/mL)

PATIENT CHARACTERISTICS:

Age:

• 18 and over

Performance status:

• Eastern Cooperative Oncology Group(ECOG) 0-2

Life expectancy:

• At least 10 years

Hematopoietic:

• White Blood Cell(WBC) at least 3,000/mm^3
• Neutrophil count at least 1,500/mm^3
• Platelet count at least 100,000/mm^3

Hepatic:

• Conjugated bilirubin no greater than upper limit of normal (ULN)
• Alkaline phosphatase no greater than 4 times ULN
• Alanine transaminase(ALT) no greater than 2 times ULN (1.5 times ULN if alkaline phosphatase greater than 2.5 times ULN)

Renal:

• Not specified

Cardiovascular:

• Ejection fraction greater than 50% by Multiple Gated Acquisition(MUGA)scan

Other:

• No other malignancy within the past 5 years except nonmelanoma skin cancer
• No significant active medical illness that would preclude study therapy
• No peripheral neuropathy grade 2 or greater
• No hypersensitivity to drugs formulated with polysorbate-80
• No significant contraindications to corticosteroids

PRIOR CONCURRENT THERAPY:

Biologic therapy:

• Not specified

Chemotherapy:

• No prior cytotoxic chemotherapy
• No other concurrent cytotoxic chemotherapy

Endocrine therapy:

• No prior or concurrent conventional hormonal therapy

Radiotherapy:

• No prior or concurrent radiotherapy (external beam or brachytherapy)

Surgery:

• See Disease Characteristics

Other:

• No prior or concurrent cryotherapy