Low, Intermediate, or High Dose Suramin in Treating Patients With Hormone-Refractory Prostate Cancer

DISEASE CHARACTERISTICS:

• Histologically proven adenocarcinoma of the prostate with progressive metastatic or progressive regional nodal disease

  • PSA evidence of progression defined as at least 50% increase over baseline on at least 2 measurements at least 2 weeks apart

• Measurable disease preferred but not required

  • Bone scan abnormalities acceptable provided PSA at least 10 ng/mL
  • No minimum PSA value required if measurable disease present
• Progression after or during an adequate trial of hormonal therapy

• No more than 3 prior hormonal interventions for progressive disease

  • One prior hormonal intervention is defined by any of the following:

    • Concurrent testicular and adrenal androgen ablation (e.g., leuprolide, goserelin, orchiectomy, or diethylstilbestrol (DES) plus flutamide, bicalutamide, nilutamide, megestrol, or other antiandrogen)
    • Initial LHRH agonist followed by orchiectomy provided no progression prior to orchiectomy
    • Prior intermittent androgen deprivation on protocol SWOG-9346
    • Corticosteroids for metastatic disease or in conjunction with aminoglutethimide or ketoconazole

  • Two prior hormonal interventions are defined by the following:

    • Antiandrogen given for disease progression more than 3 months after initial hormonal therapy
• Prior neoadjuvant or adjuvant deprivation for treatment of nonmetastatic disease not considered a prior hormonal intervention

• Antiandrogen withdrawal not considered a separate hormonal intervention

  • At least 4 weeks since antiandrogen withdrawal or megestrol withdrawal
  • Failure to respond to (i.e., no decrease in PSA at 2 and 4 weeks) or progression after a transient response to antiandrogen withdrawal or megestrol withdrawal required
• Primary testicular androgen suppression (e.g., LHRH agonist or DES) continues during study
• No brain metastases or other CNS disease

PATIENT CHARACTERISTICS:

Age:

• 18 and over

Performance status:

• CALGB 0-2 OR
• Zubrod 0-2

Life expectancy:

• At least 3 months

Hematopoietic:

• WBC at least 3,000/mm3
• Absolute neutrophil count at least 1,200/mm3
• Platelet count at least 100,000/mm3
• Hemoglobin at least 9 g/dL
• Fibrinogen at least 200 mg/dL
• No prior hemorrhagic or thrombotic disorders

Hepatic:

• Bilirubin normal
• AST/ALT no greater than 2.5 times normal
• Prothrombin time, partial thromboplastin time, and thrombin time normal

Renal:

• Creatinine clearance at least 70 mL/min

Other:

• No primary muscle disease
• No active, uncontrolled bacterial, viral, or fungal infection
• No grade 1 or worse peripheral neuropathy
• No underlying medical condition that would preclude study
• No other serious medical illness that limits survival to less than 3 months
• No psychiatric condition that would preclude informed consent
• No other malignancy within the past 5 years except inactive nonmelanomatous skin cancer or adequately treated stage I or II cancer in remission

PRIOR CONCURRENT THERAPY:

Biologic therapy:

• No prior immunotherapy for metastatic disease

Chemotherapy:

• No prior chemotherapy (including estramustine) for metastatic disease

Endocrine therapy:

• No concurrent megestrol or other hormonal agents
• No concurrent systemic or inhaled corticosteroids (intranasal and topical steroids allowed)

Radiotherapy:

• At least 4 weeks since prior radiotherapy (8 weeks for strontium therapy)

Other:

• No prior experimental therapy for metastatic disease
• No concurrent heparin, warfarin, or aspirin