Evaluation of Candidates for Upfront Docetaxel Therapy Among Patients With Metastatic Castration-sensitive Prostate Cancer from a Retrospective Multicenter Study (MAHOROBA study).

Abstract

Background/aim: It remains unclear whether patients with metastatic castration-sensitive prostate cancer (mCSPC) are suitable for upfront docetaxel therapy. Therefore, we retrospectively evaluated patients with metastatic castration-resistant prostate cancer (mCRPC) who could not receive ≥6 cycles of docetaxel for mCRPC.

Patients and methods: This study enrolled 274 patients diagnosed with mCSPC who later developed mCRPC, with data at diagnosis, including blood test results, available from 17 hospitals between 2008 and 2022. Failure to receive ≥6 cycles of docetaxel was defined as receiving ≤5 cycles of docetaxel for mCRPC or dying due to prostate cancer without docetaxel therapy. Factors at mCSPC diagnosis associated with failure to receive ≥6 cycles of docetaxel were evaluated using logistic regression analysis.

Results: Ninety-three patients were not able to receive ≥6 cycles of docetaxel for mCRPC. Multivariate analysis revealed that high lactate dehydrogenase levels and Gleason grade group 5 were significantly associated with failure receive ≥6 cycles of docetaxel for mCRPC. Furthermore, in patients with these factors at mCSPC diagnosis, receiving ≥6 cycles of docetaxel was significantly associated with better overall survival.

Conclusion: Patients with mCSPC who have high lactate dehydrogenase levels and a Gleason grade 5 may be candidates for upfront docetaxel therapy, as they may otherwise miss the chance to receive adequate doses for prostate cancer.