Waiting game.

It’s been a big decade for docetaxel in prostate cancer. So much so it is now officially recommended as a component of upfront therapy for many men with metastatic prostate cancer. So the obvious next question is whether men with biochemical recurrence can also benefit. A 2015 meta-analysis of trials that lumped in a few of these non-metastatic cases reported an improvement in failure-free but not overall survival with the addition of docetaxel prior to overt metastases. This French phase 3 trial randomized men with “high-risk” biochemical recurrence after definitive surgery or radiation to androgen deprivation therapy (ADT) x 1 year +/- docetaxel q3 weeks x 6. High-risk was defined here by certain PSA velocity metrics, a Gleason score ≥8, node-positivity or positive margin. The primary outcome of survival free from further PSA progression was virtually the same at a median of 20 months with docetaxel and 19 without. TBL: Men with prostate cancer may need mets before they can benefit from the addition of docetaxel. | Oudard, JAMA Oncol 2019