Add on Docetaxel Improves Survival for Low-PSA Prostate Cancer Patients: JAMA

A recent study published in Journal of American Medical Association suggests that adding docetaxel to standard treatment could significantly improve their chances of survival in patients with high-grade prostate cancer and low levels of prostate-specific antigen (PSA).

This comprehensive analysis of five prospective randomized clinical trials examined if supplementing standard treatment with docetaxel could reduce prostate cancer-specific mortality (PCSM) and all-cause mortality (ACM) for a specific patients groups. These patients had nonmetastatic prostate cancer, a PSA level below 4 ng/mL, and a Gleason score of 8 to 10. Treatment commenced between February 21, 2006, and December 31, 2015, with a median follow-up period of 7.1 years.

Out of a total of 2184 patients studied, 145 individuals (6.6%) from four of the trials met the criteria. The data revealed that, when compared to standard care alone, patients treated with docetaxel experienced a lower but not statistically significant risk of ACM (HR, 0.51) and PCSM (sHR, 0.42). However, for patients with a performance status of 0 (indicating good health), the benefits became more pronounced. The risk of ACM reduced significantly (HR, 0.46), and PCSM significantly lowered (sHR, 0.30) in this group.

The findings are crucial for a specific subset of prostate cancer patients – those who are otherwise in good health, have a PSA level below 4 ng/mL, and possess a Gleason score of 8 to 10. For this group, adding docetaxel to their treatment regime appears to significantly improve their chances of survival, particularly in reducing prostate cancer-specific mortality. This could potentially represent a paradigm shift in the treatment of high-grade prostate cancer.

The results of study holds promise for refining treatment strategies for a specific group of prostate cancer patients who often face a higher risk of mortality. Further research and clinical trials may be necessary to validate these findings and determine the most effective treatment protocols. Such advancements could ultimately lead to better outcomes and an improved prognosis for this patient population.

Source:

Mahal, B. A., Kwak, L., Xie, W., Eastham, J. A., James, N. D., Sandler, H. M., Feng, F. Y., Brihoum, M., Fizazi, K., Sweeney, C., Ravi, P., & D’Amico, A. V. (2023). Mortality Risk for Docetaxel-Treated, High-Grade Prostate Cancer With Low PSA Levels. In JAMA Network Open (Vol. 6, Issue 11, p. e2340787). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2023.40787