Yesterday’s post was about the use of chemotherapy (with docetaxel) for the treatment of men with advanced prostate cancer who were 80 years old or older. Today’s post is about the use of chemotherapy in men 60 years or younger. The research for both of these posts was performed by the same team of scientists in a multicenter retrospective study in Italy.
A large portion of prostate cancer is diagnosed in men over the age of 60 years so castration-resistant prostate cancer (CRPC) is rarely observed in men younger than 60 years. As a result the clinical outcomes of these younger men have not been clearly defined. There is a common feeling of a worse prognosis for these younger men. In the study which is the topic of this post the aim is to assess the clinical outcomes of this specific population.
The researchers reviewed the clinical records of all the men younger than 60 with CRPC from participating institutions, treated with docetaxel (DOC), both in clinical trials and in clinical practice. They recorded the pre- and post-DOC clinical history, the DOC treatment details and outcomes.
As of the date of publication they have collected a consecutive series of information on 128 men from 24 Italian hospitalsThe median age was 57 (range 41 to 60). The median baseline prostate-specific antigen (PSA) was 85 ng/ml (range 1 to 3,020); 87% of the pts had bone metastases while 47%, 10%, and 13% showed nodal, liver and lung metastases, respectively.
All but 12 of the men received DOC with a 3 week standard schedule, the remaining being treated with a weekly, reduced dosage schedule.
A PSA reduction greater than 50% was observed in 61% of the the men; among the 86 men with measurable disease who underwent a radiological re-evaluation at the treatment end, four and 13 men achieved complete and partial response, respectively (response rate 20%).
The main grade 3-4 toxicities were anemia (five men), neutropenia (18 men), febrile neutropenia (one man), fatigue (five men), peripheral neuropathy (three men). The median progression-free survival (PFS) and overall survival (OS) were 7 months and 21 months, while the 1 year PFS and OS rates were 17.6% and 74.9%, respectively.
Their data seems to not confirm that younger men with CRPC have a worse prognosis compared to the older men since their survival outcomes and response rate are similar to those observed in general population of men with CRPC.
J Clin Oncol 32, 2014 (suppl 4; abstr 214); Antonello Veccia, Cinzia Ortega, Giuseppe di Lorenzo, Francesca La Russa, Salvatore Luca Burgio, Gaetano Facchini, Caterina Messina, Cosimo Sacco, Gilbert Spizzo, Michele Aieta, Michele Lodde, Giovanni Mansueto, Paolo A. Zucali, Alessandro D’Angelo, Roberto Iacovelli, Francesco Massari, Franco Morelli, Giuseppe Procopio, Fiorella Ruatta, Orazio Caffo, CYCLOP Study Group.
Joel T. Nowak, M.A., M.S.W.