Definition |
A significant improvement in median survival of 2-2.5 months occurred with docetaxel-based chemotherapy compared to mitoxantrone + prednisone therapy. The standard for first-line cytotoxic chemotherapy is docetaxel using the same regimen as in the TAX 327 trial, that is, 75 mg/m2 3 weekly combined with prednisone 5 mg BID, up to 10 cycles, and palliation is the main target. The patients considered for docetaxel represent a heterogeneous population. Several poor prognostic factors have been described, such as a PSA level > 114 ng/mL, PSA-DT < 55 days, or the presence of visceral metastases. A better risk group definition has recently been presented, based on the TAX 327 study cohort. The predictive factors were visceral metastases, pain, anaemia (Hb < 13 g/dL), bone scan progression, and prior estramustine before docetaxel. Patients were categorised into three risk groups: low risk (0 or 1 factor), intermediate (2 factors) and high risk (3 or 4 factors), leading to three different lengths of median OS: 25.7, 18.7 and 12.8 months, respectively. In addition, two independent studies have suggested that improved survival can be predicted by C-reactive protein (CRP) levels < 8 mg/L (HR, 2.96). Age by itself is not a contraindication to docetaxel.
|