Long-term survival of patients with locally advanced prostate cancer managed with neoadjuvant docetaxel and radical prostatectomy

• Published in: Urologic oncology 2015-04, Vol.33 (4), p.164.e19-164.e23
• Main Authors: Zhao, Bo, M.D., Ph.D, Yerram, Nitin K., M.D, Gao, Tianming, M.S, Dreicer, Robert, M.D., M.S, Klein, Eric A., M.D
• Format: Article
• Language: English
• Subjects: Aged; Antineoplastic Agents - administration & dosage; Chemotherapy, Adjuvant; Combined Modality Therapy; Docetaxel; Humans; Kaplan-Meier Estimate; Locally-advanced; Male; Middle Aged; Neoadjuvant; Neoadjuvant Therapy; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - mortality; Proportional Hazards Models; Prostate cancer; Prostate-Specific Antigen - blood; Prostatectomy; Prostatic Neoplasms - drug therapy; Prostatic Neoplasms - mortality; Prostatic Neoplasms - surgery; Radical prostatectomy; Taxoids - administration & dosage; Treatment Outcome; Urology
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2015.01.001

Abstract Background Patients with locally advanced prostate cancer (PCa) have worse outcomes after radical prostatectomy (RP) than patients with more favorable parameters. We conducted a phase II study of neoadjuvant chemotherapy with docetaxel before RP during 2000 to 2003 in patients with locally advanced disease. We report an updated long-term survival analysis of these patients. Material and methods Overall, 28 patients with locally advanced PCa (defined as serum preoperative [initial] prostate-specific antigen level≥15 ng/ml, clinical≥T2b disease, or biopsy Gleason score ≥8) and no evidence of metastatic disease received 6 weekly doses of intravenous docetaxel (40 mg/m2 ) followed by RP. Disease status was assessed by shared medical records or followed by phone and fax. Biochemical recurrence (BCR) was defined as 2 consecutive prostate-specific antigen level readings≥0.2 ng/ml. A Social Security Death Index search was conducted on all patients to ascertain date of death if unavailable in records. Results In total, 28 patients completed chemotherapy and underwent RP. At a median follow-up of 130 months (range: 37–166 mo), 10 patients (36%) remained alive and disease free clinically and biochemically with no additional therapy, whereas 18 patients (64%) had BCR. The estimated 10-year BCR-free survival is 33.5%, metastasis-free survival is 68.7%, PCa-specific survival is 92.2%, and overall survival is 79.7%. Conclusions The use of neoadjuvant docetaxel chemotherapy in patients with locally advanced PCa undergoing RP remains undefined. Results from this study are informative but only hypothesis generating given the study was not powered for survival. Mature data from the ongoing CALGB 90203 and GETUG-12 studies will shed light on this clinical question.