Androgen-deprivation therapy (ADT) has been the standard of care for advanced prostate cancer since the 1940s. According to the CHAARTED trial, upfront chemotherapy improved overall survival and time to progression in high volume metastatic hormone-sensitivity prostate cancer (mHSPC). We present our experience about upfront chemotherapy for high volume mHSPC.
14 men with high volume metastatic, hormone-sensitive prostate cancer received upfront docetaxel chemotherapy within the first 3 months of ADT. 56 patients with high volume metastatic hormone-sensitive prostate cancer received ADT alone. Primary end-point is the time to biochemical failure and 2nd end-point is the rate of nadir PSA level less than 1 ng per milliliter.
A total of 14 patients received combination of ADT and Docetaxel chemotherapy. (Median age 71.5, range from 48 to 83 years old; medina iPSA 424.4 ng/ml, range from 15.71 to 2293; one patient has Gleason 7, one has Gleason 8, eight have Gleason 9 and three patinets have Gleason 10; three patients have visceral metastasis). Eight patients had biochemical progression (the median time 9.5 months; and range: from 2 months to 18 months). Fifty percent (7/14) of the patient had their nadir PSA level less than 1 ng per milliliter after upfront chemotherapy. 56 patients were received ADT alone. (Median age 73.5, range from 52- to 85-year-old; Medina iPSA 311.5 ng/ml, range from 9.69 to 8403; three patients have Gleason 7, seven patients have Gleason 8, 33patients have Gleason 9 and seven patients have Gleason 10; five patients have visceral metastasis. 33% (17/51) of patients had nadir PSA level less than 1 ng per milliliter after ADT alone. Although the median time of biochemical failure of ADT with chemotherapy versus ADT alone was 9.5 months versus 12 months, the other six patients received ADT with chemotherapy still do not achieve biochemical failure (39 Ms, 24 Ms, 24 Ms, 12 Ms, 9 Ms, 8 Ms).
In our early experience of upfront chemotherapy, combining with ADT was well tolerable. The combination seemed to augment the tumor control in high risk mHSPC.
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All authors have declared no conflicts of interest.