Should docetaxel be administered earlier in prostate cancer therapy?

Three randomized studies examining docetaxel early in metastatic prostate cancer were recently reported. The CHAARTED and STAMPEDE studies showed a survival benefit for docetaxel when started with androgen suppression therapy in men with newly diagnosed metastatic prostate cancer. The STAMPEDE study also included men with biochemically relapsed prostate cancer. The benefit was a median of 13.6 months in the CHAARTED study and 10 months in STAMPEDE. The survival benefit in CHAARTED was stronger in those with high volume disease. The benefit in STAMPEDE was greater in metastatic, rather than biochemically relapsed, prostate cancer. The third study, GETUG-AFU 15, was a smaller study without a survival benefit. These data have changed how we treat metastatic prostate cancer at our centers, as we now offer all men with metastatic castration sensitive prostate cancer docetaxel chemotherapy upfront.