No benefit of adding docetaxel to ADT+RT in treating localized high-risk or pelvic lymph node only (N1) newly-diagnosed patients

[Tall_Allen]

I updated this with the most recent STAMPEDE trial of adding docetaxel to ADT in what they call "high-risk" patients.

prostatecancer.news/2016/08...

[cesces]

It's helpful when you post updates to your pages on health unlocked.

Thanks

[Scout4answers]

Great news

[Seasid]

In 2018 when I was newly diagnosed I found a Finnish study conforming exactly this what you are saying.

I myself still had chemotherapy as my cancer was wide spread.

[timotur]

This confirms my research three years ago when looking at early Docetaxel for Stg3bN1M0 GL-7. MO pushed for it, but GETUG-12 and SPCG-12/13 showed no extended MFS/DFS, and the Scandinavian studies had patient populations that better fit my profile of < GL7, and that swayed me not to do it.

ascopubs.org/doi/10.1200/JC...

GETUG-12 demonstrated no statistically significant improvement in a prespecified end point of metastasis-free survival. In addition, the Scandinavian trial SPCG-13 (Scandinavian Prostate Cancer Group) demonstrated no benefit in biochemical DFS in a cohort of 378 men with intermediate- or high-risk disease randomly assigned to AS (12 months) plus adjuvant CT with six cycles of docetaxel CT versus AS alone. Similarly, the SPCG-12 study showed no benefit in biochemical DFS for 459 high-risk patients randomly assigned to radical prostatectomy plus adjuvant CT with six cycles of docetaxel chemotherapy versus radical prostatectomy alone.22

The discordance in results between RTOG 0521, which showed benefits in OS, DM, and DFS, and GETUG-12, SPCG-13, and SPCG-12 may stem from differences in patient populations among the studies. The RTOG 0521 cohort included patients with more aggressive disease; 84% of patients in RTOG 0521 had a Gleason score 8 to 10 disease, whereas a majority of patients in GETUG-12, SPCG-13, and SPCG-12 had a Gleason score less than or equal to 7 disease. These differences underscore the need to select high-risk patients with the most aggressive disease when considering treatment with adjuvant docetaxel.

[podsart]

Would you classify 4+3 essentially an 8 Gleason, for most practical circumstances? If true, when you read <8 Gleason in a study, a 4+3 probability applies as well?

[Tall_Allen in reply to podsart]

High risk is defined as Gleason score 8-10 or PSA>20 or stage T3/4. STAMPEDE included men who had positive nodes too (N1). But if there is no benefit for high risk, there is no benefit for intermediate risk either.

[podsart in reply to Tall_Allen]

Thanks

[6357axbz]

Does the “no benefit” finding apply to high risk (GL) oligometastatic?

[Tall_Allen in reply to 6357axbz]

Only applies to N1 M0

[6357axbz]

Afraid so. Thanks.