What evidence is he citing that chemo has any benefit before mets are detectable, or is he recommending a clinical trial? (I'm sure he is suggesting chemo+ADT rather than chemo in lieu of ADT)
The STAMPEDE trial included 230 men who had no distant mets (M0) and received docetaxel+ADT. They did no better than the men who only got ADT. There were only 28 men with recurrent disease who got docetaxel+ADT, and they did no better than the men who didn't get docetaxel, but the sample size was too small to draw definitive conclusions.
There was a small trial reported last year using docetaxel and bevacizumab (an angiogenesis inhibitor) + ADT in 42 men with recurrent disease and a rapid PSADT. After short followup, 20% were free of progression, but over half experienced serious adverse events. They cite a similar study using docetaxel + estramustine that had similar findings.
Docetaxel, bevacizumab, and androgen deprivation therapy for biochemical relapse after definitive local therapy for prostate cancerGiven that there is nothing definitive for men in your situation, you have to decide for yourself whether it's worth the risk.
- Allen