Long-term efficacy of the treatment for metastatic castration-resistant prostate cancer

Abstract

Objective To:investigate the role of docetaxel and prednisone on treating metastatic castration-resistant prostate cancer (mCRPC),and to report the long-term efficacy.Methods From July 2005 to March 2012,299 mCRPC patients were nonrandomised into two groups.Docetaxel (75 mg/m2) and prednisone (5 mg,bid) were given to patients in Group A,with a chemotherapy cycle of three-week.And the other patients in group B were treated with endocrine therapy,radiotherapy,traditional Chinese medicine,and so on.102 cases were nonrandomised into group A,with age range from 50 to 86 years (median 72 years),tPSA range from 9.9 μg/L to 5000.0 μg/L (median 94.0 μg/L),Gleason score range from 6 to 10 (median 7),pain score range from 0 to 7 (median 2),bone metastasis in 98 cases,lung metastasis in 1 1 cases,liver metastasis in 5 cases,lymph node metastasis in 19 cases,and the time from prostate cancer diagnosis to mCRPC range from 5.4 months to 123.2 months (median 18.6 months).The tPSA,pain score,bone scan,and metastatic focuses before and after chemotherapy were compared.197 patients were nonrandomised in group B,with age range from 54 to 85 years (median 73 years),tPSA range from 5.4 μg/L to 1270.0 μg/L (median 71.0 μg/L),Gleason score range from 6 to 10 (median 7),pain score range from 0 to 4 (median 2),bone metastasis in 176 cases,lung metastasis in 17 cases,liver metastasis in 6 cases,lymph node metastasis in 43 cases,and the time from prostate cancer diagnosis to mCRPC range from 6.0 months to 137.1 months (median 18.4 months).SPSS (v10.0),t and x2 analysis are used to evaluate the baseline differences between the 2 groups,and Kaplan-Meier survival curves are used to evaluate the overall survival between the two groups.Results There is no difference between the two group on baseline.In group A,100-170 milligram docetaxel were given for each cycle,1-12 cycles were experienced.The PSA responses were excellent in 59 cases (57.8％),effective in 21 cases (20.6％),useless in 22 cases (21.6％),and PSA response ratio was 78.4％ (80 cases).98 patients were suffered from bone metastasis.Bone scan improved in 33 cases (33.7％),stable in 47 cases (48.0％),progressed in 18 cases (18.4％).There are 11 cases with lung metastasis,improved in 5 cases (45.5％),progressed in 3 cases (27.3％),and stable in other cases after chemotherapy.There are 5 cases with liver metastasis,improved in 1 case,progressed in 4 cases.Among 19 N1 cases,lymph nodes diminished in 5 cases (26.3％),enlarged in 2 case (10.5％) and stable in 12 cases (63.2％) after chemotherapy.Pain scores were decreased in 38 cases (37.3％),increased in 27 cases (26.5％),and no different in 37 cases (36.3％).The median overall survival in group A is 28.3 months,and 23.9 months in group B.Extra median 4.4 months survival benefit is showed in group A.The common adverse events were myelosuppression,alopecia,fatigue,numbness in the end of limbs,nail changes,phlebitis.Conclusions Docetaxel combined with prednisone for the treatment of mCRPC can delay the progression of the disease,prolong the overall survival,decrease the PSA value,diminish the metastatic focuses,ease the pain,improvc thc quality of lifc,and thc tolcrance is quite good. Key words: Prostate cancer; Chemotherapy; Docetaxel; Prednisone