Research in context
Evidence before this study
When this trial began in 2002, the best treatment for patients with high-risk localised prostate cancer was debated, as it is now, although some evidence supports the use of prolonged ADT combined with radiotherapy. Docetaxel improves survival in patients with metastatic prostate cancer. In September, 2002, we searched PubMed and the proceedings of American Society of Clinical Oncology and European Society for Medical Oncology congresses for randomised phase 3 trials testing docetaxel-based chemotherapy for patients with localised prostate cancer and found none. We repeated the search on March 1, 2015 and found the same results.
Added value of this study
To our knowledge, GETUG 12 shows for the first time that integrating docetaxel and estramustine into the standard care of patients with high-risk localised prostate cancer is associated with a significant improvement of relapse-free survival, with no apparent long-term toxic effects related to chemotherapy.
Implications of all of the available evidence
After a decade when chemotherapy was restricted to patients with metastatic castrate-resistant prostate cancer, the early use of docetaxel-based chemotherapy is becoming an important option for patients who have not developed castration-resistant disease. Longer follow-up of this trial and results of other ongoing studies are needed to establish whether the benefit in relapse-free survival translates into improved metastasis-free survival and overall survival.