Effect of docetaxel added to bicalutamide in Hormone-Naïve non-metastatic prostate cancer with rising PSA, a randomized clinical trial (SPCG-14)

Andreas Josefsson, Åsa Jellvert, Erik Holmberg, Klaus Brasso, Peter Meidahl Petersen, Sirpa Aaltomaa, Marjaana Luukkaa, Paul Verhagen, Ronald de Wit, Göran Ahlgren, Ove Andrén, Enrique Castellanos, Mihalj Seke, Anders Widmark, Jan-Erik Damber & the SPCG14-investigators

ACTA ONCOLOGICA 2023, VOL. 62, NO. 4, 372–380


Background: Historically, endocrine therapy was used in a range of scenarios in patients with rising

PSA, both as a treatment for locally advanced non-metastatic prostate cancer and PSA recurrence following

curative intended therapy. In the present study the objective was to investigate if chemotherapy

added to endocrine therapy could improve progression-free survival (PFS).

Materials and Methods: Patients with hormone-naïve, non-metastatic prostate cancer and rising prostate-

specific antigen (PSA), enrolled from Sweden, Denmark, the Netherlands, and Finland, were

randomized to long-term bicalutamide (150mg daily) or plus docetaxel (75 mg/m2, q3w, 8–10 cycles)

without prednisone, after stratification for the site, prior local therapy or not, and PSA doubling time.

The primary endpoint was 5-year PFS analyzed with a stratified Cox proportional hazards regression

model on intention to treat basis.

Results: Between 2009 and 2018, a total of 348 patients were randomized; 315 patients had PSA

relapse after radical treatment, 33 patients had no prior local therapy. Median follow-up was 4.9 years

(IQR 4.0–5.1). Adding docetaxel improved PFS (HR 0.68, 95% CI 0.50–0.93; p.0.015). Docetaxel

showed an advantage for patients with PSA relapse after prior local therapy (HR 0.67, 95% CI 0.49–

0.94; p.0.019). One event of neutropenic infection/fever occurred in 27% of the patients receiving

docetaxel. Limitations were slow recruitment, lack of enrolling patients without radical local treatment,

and too short follow-up for evaluation of overall survival in patients with PSA relapse.

Conclusion: Docetaxel improved PFS in patients starting bicalutamide due to PSA relapse after local

therapy or localized disease without local therapy. Confirmatory studies of the efficacy of docetaxel in

the setting of PSA-only relapse in addition to endocrine therapies may be justified if longer follow-up

will show increased metastatic-free survival.