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Abstract
In the targeted therapy era, it is critical to know the certain points to start or discontinue chemotherapy for patients with castration resistant metastatic prostate cancer. The prognostic factors to determine this response are still not clear yet. We tried to find out if the PSA doubling time helps us to predict the patients who will benefit from docetaxel chemotherapy most, and also to question the value of the PSA response to chemotherapy. Retrospectively, 70 patients who had hormone refractory metastatic prostate cancer that were given at least 4 cycles of docetaxel chemotherapy between 2002 and 2015 were evaluated. After the onset of docetaxel, PSA response to therapy and overall survival rates were analyzed to figure out if these parameters were related to PSA doubling time. The only statistically significant prognostic parameter affecting overall survival was the best PSA response rate to docetaxel chemotherapy being over or under 50%. The most significant parameter that affects the PSA doubling time was the clinical stage at the time of diagnosis. PSA doubling time is not a useful predictive tool for predicting response to docetaxel. By means of overall survival, the clinical stage at the time of diagnosis was the best predictive tool for our cohort. The best PSA response rate to docetaxel chemotherapy was found to be a valuable parameter. The study being retrospective and the low number of patients included in this cohort can be the main weaknesses of this study. Further studies to determine which other factors can be useful are needed.
Highlights
Prostate cancer is the most common visceral malignancy amongst men in the US [1]
The survival of patients with metastatic prostate cancer progressing on androgen deprivation therapy (ADT) has improved substantially
In addition to docetaxel, which has been used for over a decade, new drugs have shown efficacy with improvements in overall survival leading to licensing for the treatment of metastatic castration-resistant prostate cancer (CRPC)
Summary
Prostate cancer is the most common visceral malignancy amongst men in the US [1]. In addition, it is the most common solid cancer and the most common cause of death due to cancer in European men [2]. Men with localised disease can have very different treatment options, ranging from observation alone through to radical surgery, for each individual patient For those who have metastatic prostate cancer, the most common first line treatment option is androgen deprivation therapy (ADT). In addition to docetaxel, which has been used for over a decade, new drugs have shown efficacy with improvements in overall survival leading to licensing for the treatment of metastatic castration-resistant prostate cancer (CRPC). Because of these recent changes in the therapeutic landscape, no vigorous data is available to inform on the selection of patients for a specific treatment for CRPC [6] [7]. With the developments in the last decade, we have many options for hormone refractory metastatic prostate cancer patients like newer generation chemotherapeutics, targeted therapies, vaccines, immune checkpoint inhibitors [8]-[11]
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