Background: Current treatment guidelines for patients with metastatic castrate sensitive prostate cancer (mCSPC) recommend the use of upfront docetaxel chemotherapy in addition to androgen deprivation therapy (ADT). We explored reasons for clinical variations to recommendations for chemotherapy and outcomes of this patient cohort.
Methods: This retrospective study investigated patients with newly diagnosed de-novo mCSPC in South West Sydney Local Health District (SWSLHD) between 2015–2018. Patient demographics, tumour characteristics and survival outcomes were collected.
Results: 80 patients with de-novo mCSPC were included (median age 72 years; 73% ECOG PS ≤ 1; 23% CALD; 50% high volume on conventional imaging). 85% (n=68) were deemed suitable for upfront docetaxel after patients with ECOG PS ≥ 2 or ≥ 90 years were excluded. Oncologists discussed upfront docetaxel with 81% (n=55) of patients during their initial visit with 56% (n=31) receiving docetaxel. Of the 24 patients who did not receive docetaxel despite initial discussion, 50% (n=12) were subsequently considered medically unfit, 8% (n=2) with low volume disease and 8% (n=2) declined with 33% (n=8) not having a documented reason. 76% (n=16) of CALD patients did not receive docetaxel compared with 64% (n=33) of non-CALD patients. OS was 44.4 months for patients on chemotherapy plus ADT versus 22.3 months for patients on ADT alone with median follow-up of 36.8 months. There was a non-significant trend towards worse OS in CALD versus non-CALD patients (32.1 versus 39.4 months, p=0.39).
Conclusions: Upfront docetaxel chemotherapy was discussed in the majority of patients however only approximately half of all patients with ECOG PS ≤ 1 and younger than 90 received chemotherapy. Overall survival of patients who received chemotherapy in our cohort was worse compared to those in pivotal phase 3 clinical trials. This may reflect differences in our patient cohort such as age, comorbidity burden, performance status or ethnicity.