THE CHAARTED trial’s ten-year follow-up confirms that adding docetaxel to androgen deprivation therapy (ADT) provides an overall survival benefit for men with metastatic hormone-sensitive prostate cancer, particularly those with a high burden of disease.
This long-term analysis stratified outcomes by baseline disease volume and by prostate-specific antigen (PSA) measured at six months, calculating overall survival with Kaplan–Meier estimates and applying multivariable Cox regression to adjust for treatment arm, disease volume, Gleason score and prior local therapy. A total of 790 patients were included and, after a median follow-up of ten years, 225 patients remained alive without a recorded date of death. At ten years, overall survival was 25.9% in the ADT plus docetaxel group compared with 22.5% in the ADT-alone group, corresponding to a hazard ratio of 0.78 (p=0.004).
The survival advantage was most pronounced among patients with high-volume disease: those who received docetaxel had a ten-year overall survival of 20.9% compared with 11.4% for ADT alone (p<0.0001), emphasising the relevance of disease burden when selecting upfront intensification. PSA response at six months emerged as a powerful prognostic marker. Patients who achieved a PSA nadir below 0.2 ng/mL by six months experienced substantially longer median overall survival in both arms, 100.3 months versus 45.4 months with ADT plus docetaxel, and 116.8 months versus 31.8 months with ADT alone (both p<0.0001).
On multivariable analysis, a six-month PSA below 0.2 ng/mL remained independently associated with improved survival (hazard ratio 0.41; p<0.0001), irrespective of disease volume, prior local therapy or Gleason score.
These findings support the consideration of upfront docetaxel for men with high-volume metastatic disease and position the six-month PSA nadir as an early biomarker to guide response-adapted strategies. Integrating PSA dynamics with clinical and pathological features may allow clinicians to personalise treatment intensity, safely de-escalate therapy for patients who achieve deep early biochemical responses and focus escalation on those at highest risk. The results should prompt discussion in multidisciplinary teams and inspire future clinical trials.
Reference
Tripathi A et al. Ten-year survival rates by PSA nadir in patients with metastatic hormone-sensitive prostate cancer: long-term survival analysis from the ECOG-ACRIN 3805 (CHAARTED) trial. Ann Oncol. 2025;DOI:10.1016/j.annonc.2025.08.004.
