Chemotherapy in hormone-refractory prostate cancer

The results of the TAX 327 and SWOG 99-16 trials for the first time showed an improvement in overall survival (OS) with docetaxel-based chemotherapy in patients with metastatic hormone-refractory prostate cancer. As such, 3-weekly (q3w) docetaxel plus low-dose prednisone is widely considered to be the treatment of choice for these patients. An updated survival analysis from TAX 327 confirms that benefits observed with docetaxel are sustained at 3 years. Furthermore, q3w docetaxel plus prednisone was effective in all patient subgroups investigated, regardless of age, presence or absence of pain, and performance status. Multivariate analysis has shown that prostate-specific antigen (PSA) concentrations and kinetics (pre-treatment PSA doubling time; PSADT) are independent prognostic factors for survival in the TAX 327 cohort, along with pain, number of metastatic sites and measurable disease. Patients with baseline PSA concentrations of < 114 ng/mL and PSADT >= 55 days have a median overall survival of 25 months while those with PSA concentrations of >= 114 ng/mL and a PSADT of < 55 days have a median overall survival of only 14 months. A PSA decline of >= 30% within 3 months' therapy with docetaxel is also a surrogate of OS. Measurements such as these, and the use of predictive nomograms, can assist the physician in identifying patients at high risk of disease progression who may benefit from earlier treatment with chemotherapy.