Historically, endocrine therapy was used in a range of scenarios in patients with rising PSA, both as a treatment for locally advanced non-metastatic prostate cancer and PSA recurrence following curative intended therapy. In the present study the objective was to investigate if chemotherapy added to endocrine therapy could improve progression-free survival (PFS).
Patients with hormone-naïve, non-metastatic prostate cancer and rising prostate-specific antigen (PSA), enrolled from Sweden, Denmark, the Netherlands, and Finland, were randomized to long-term bicalutamide (150 mg daily) or plus docetaxel (75 mg/m2, q3w, 8-10 cycles) without prednisone, after stratification for the site, prior local therapy or not, and PSA doubling time. The primary endpoint was 5-year PFS analyzed with a stratified Cox proportional hazards regression model on intention to treat basis.
Between 2009 and 2018, a total of 348 patients were randomized; 315 patients had PSA relapse after radical treatment, 33 patients had no prior local therapy. Median follow-up was 4.9 years (IQR 4.0-5.1). Adding docetaxel improved PFS (HR 0.68, 95% CI 0.50-0.93; p = 0.015). Docetaxel showed an advantage for patients with PSA relapse after prior local therapy (HR 0.67, 95% CI 0.49-0.94; p = 0.019). One event of neutropenic infection/fever occurred in 27% of the patients receiving docetaxel. Limitations were slow recruitment, lack of enrolling patients without radical local treatment, and too short follow-up for evaluation of overall survival in patients with PSA relapse.
Docetaxel improved PFS in patients starting bicalutamide due to PSA relapse after local therapy or localized disease without local therapy. Confirmatory studies of the efficacy of docetaxel in the setting of PSA-only relapse in addition to endocrine therapies may be justified if longer follow-up will show increased metastatic-free survival.
Acta oncologica (Stockholm, Sweden). 2023 Apr 19 [Epub ahead of print]
Andreas Josefsson, Åsa Jellvert, Erik Holmberg, Klaus Brasso, Peter Meidahl Petersen, Sirpa Aaltomaa, Marjaana Luukkaa, Paul Verhagen, Ronald de Wit, Göran Ahlgren, Ove Andrén, Enrique Castellanos, Mihalj Seke, Anders Widmark, Jan-Erik Damber, SPCG14-investigators
Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden., Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden., Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark., Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark., Department of Urology, Kuopio University Hospital, Kuopio, Finland., Department of Oncology, Turku University Hospital, Turku, Finland., Department of Urology, Erasmus Medical Centre, Rotterdam, the Netherlands., Department of Medical Oncology, Erasmus University Medical Centre Cancer Institute, Rotterdam, the Netherlands., Department of Urology, Lund University, Skåne University Hospital, Sweden., School of Medical Sciences, Örebro University, Örebro, Sweden., Department of Oncology, Karolinska University Hospital, Stockholm, Sweden., Centrallasarettet Växjö, Växjö, Sweden., Department of Radiation Sciences, Umeå University, Umeå, Sweden.