title: Population-based impact on overall survival after the introduction of docetaxel as standard therapy for metastatic castration resistant prostate cancer.
abstract: BACKGROUND
  Utilization of docetaxel in patients with metastatic castration resistant prostate cancer (mCRPC) remains low despite its demonstrated survival benefit. In a population-based cohort, we sought to determine whether the introduction of docetaxel has improved overall survival (OS).
  
  
  METHODS
  A retrospective review was conducted of mCRPC patients treated with palliative radiotherapy to bone in British Columbia, Canada. Patients in the pre-docetaxel era (pre-DOC, prior to general availability of docetaxel for CRPC) received radiotherapy to bone (RT-B) from 1998 to 2001 and those in the docetaxel era (DOC) received radiotherapy from 2006 to 2009. Time of first radiotherapy to bone was used to select patients at a similar point in their disease state (i.e., onset of bone pain). The primary objective was to determine median OS in the two eras.
  
  
  RESULTS
  Of the 919 patients in the pre-DOC era and the 957 in the DOC era, 7% and 37% received docetaxel, respectively. The median OS from time of first palliative RT was 7.5 months versus 10.3 months (hazard ratio [HR]: 0.79, 95% confidence interval [CI] 0.72-0.87; p < 0.0001) in the pre-DOC and DOC cohorts, respectively. On multivariable analyses, both eras treated (HR 0.84; p = 0.001) and the receipt of docetaxel (HR 0.78; p < 0.001) were significantly associated with OS.
  
  
  CONCLUSIONS
  Although docetaxel penetrance was <50%, median OS was significantly improved in the DOC era compared to the pre-DOC era. This is the first study to demonstrate that docetaxel improves OS in mCRPC patients at a population level.
authors.affiliation: BC Cancer Agency, Vancouver Centre, Department of Medical Oncology, British Columbia Cancer Agency, Vancouver BC;
authors.forename: Robert R
authors.initials: RR
authors.lastname: Zielinski
authors.affiliation: BC Cancer Agency, Vancouver Centre, Department of Medical Oncology, British Columbia Cancer Agency, Vancouver BC;
authors.forename: Arun A
authors.initials: AA
authors.lastname: Azad
authors.affiliation: BC Cancer Agency, Vancouver Centre, Department of Medical Oncology, British Columbia Cancer Agency, Vancouver BC; ; BC Cancer Agency, Vancouver Centre, Department of Radiation Oncology, University of British Columbia, Vancouver, BC.
authors.forename: Kim N
authors.initials: KN
authors.lastname: Chi
authors.affiliation: BC Cancer Agency, Vancouver Centre, Department of Medical Oncology, British Columbia Cancer Agency, Vancouver BC; ; BC Cancer Agency, Vancouver Centre, Department of Radiation Oncology, University of British Columbia, Vancouver, BC.
authors.forename: Scott
authors.initials: S
authors.lastname: Tyldesely