Background: The use of chemotherapy in the treatment of metastatic castrate-resistant prostate cancer (mCRPC) is increasing. This retrospective review evaluated the use of docetaxel in very elderly men with mCRPC treated in routine clinical practice.

Methods: Men with mCRPC aged ≥ 80 years and treated with docetaxel were identified from the databases of three hospitals from a period of five years.

Results: Twenty patients (pts) were identified, with a median age of 83 years (range 80-93 years). Aside from one patient treated weekly, all pts were treated with the standard three-weekly regimen of docetaxel (75mg/m²) with a median of six cycles (range 1-10 cycles) delivered. Serum PSA was available for sixteen pts, of whom nine (56%) had a PSA response of ≥ 50% and one (6%) had a PSA-complete response. The median overall survival in this cohort was 13.2 months (range 1.3-40.2 months). Five pts (25%) had an initial dose reduction and a further eleven pts (55%) had subsequent dose delays or dose reductions. Eight pts (40%) completed planned treatment. Treatment was ceased early in three pts (15%) due to toxicity; four (20%) for progression and five (25%) for other reasons. Grade 3/4 haematologic toxicity was observed in eight pts (40%) and five pts (25%) were admitted to hospital with chemotherapy-related complications.

Conclusion: Very elderly pts (80+ years) with mCRPC are infrequently included in clinical trials, yet the use of chemotherapy in this population is likely to increase. Our series demonstrates significant response rates to docetaxel chemotherapy but that a substantial number of patients had treatment-related complications. This highlights the need for careful patient selection and optimisation of chemotherapy dosing.