A small study of 145 men with asymptomatic metastatic hormone-refractory prostate cancer (HRPC) was conducted to determine the benefit of starting early chemotherapy with docetaxel.

Collected data were analyzed from these subjects who were treated with chemotherapy between February 2000 and June 2002 in one French center. The men were categorized into three groups according to their reported bone pain at baseline, i.e. minimal/no pain, mild, and moderate/severe pain. The study’s primary endpoint was the relationship of bone pain on overall survival (OS).

Sixty seven percent (67%) of the subjects were given docetaxel. The risk of death was 1.56 and 2.11 times higher for patients with mild or moderate/severe pain than for those with minimal/no pain (P = 0.027). The median (95% confidence interval (CI)) OS was 23.1 (18.5-27.6) and 14.1 (8.9-19.2) months (P = 0.001, log-rank-test) for patients with minimal pain or no pain treated with docetaxel-based chemotherapy compared with mitoxantrone, respectively. The prostate-specific antigen doubling time (PSA-DT) had a significant effect on OS in patients with minimal/no pain, with a median of 32.4 and 16.5 months for a PSA-DT of >/=45 and < 45 days, respectively (P < 0.001).These results indicate that men with HRPC and minimal or no bone pain could have better survival than those with mild pain or moderate to severe pain, independent of the treatment administered. In addition, patients with HRPC and minimal or no bone pain treated with docetaxel-based chemotherapy have a significantly better OS than those treated with mitoxantrone. The PSA-DT can be useful to identify asymptomatic patients who are candidates for early treatment.Reference: BJU Int. 2009 Feb 6. Epub ahead of print. doi:10.1111/j.1464-410X; Oudard S, Banu E, Medioni J, Scotte F, Banu A, Levy E, Wasserman J, Kacso G, Andrieu JM.PubMed Abstract PMID:19210673Joel T Nowak MA, MSW