Role of Chemotherapy in Nonmetastatic Hormone-Refractory Prostate Cancer

Context: Docetaxel chemotherapy has become the standard first-line treatment for metastatic hormone-refractory prostate cancer (HRPC). Nowadays, one of the goals of research is to determine optimal management strategies for different patient populations with prostate cancer. Objective: Because the utility or-docetaxel inpatients with nonmetastatic HRPC has not yet been evaluated, one of the most challenging questions is to define the role of chemotherapy in nonmetastatic HRPC. Evidence acquisition: in a recently published subset analysis of TAX-327, a multivariate prognostic model incorporating prostate-specific antigen (PSA) kinetics has been developed to predict survival at 1, 2, and 5 yr in men with metastatic HRPC treated with chemotherapy. This novel model includes PSA doubling time (PSA DT), baseline pain, baseline PSA level, age, type of progression at baseline (measurable disease or bone scan compared with PSA only), presence of liver metastases, and the number of metastatic disease sites. Evidence synthesis: The authors found a statistically significantly better overall survival in patients with PSA <= 114 ng/ml and PSA DT >55 d. Patients with a PSA DT of 55 d had a worse prognosis than patients with a longer PSA DT. Conclusions: Based on these findings, it seems clear nowadays that evaluation of PSA kinetics can. help us to delineate the potential benefits of the early indication of chemotherapy. It could be hypothesized that docetaxel-based chemotherapy could have a role in those patients with nonmetastatic HRPC who have a very short PSA DT. (c) 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.