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Prognostic Role of Prostate-specific Antigen Isoforms and Their Early Kinetics in Patients With Metastatic Castration-resistant Prostate Cancer Receiving New Generation Androgen Receptor Targeted Agents

  • 0Department of Oncology and Radiotherapeutics, Faculty of Medicine and University Hospital in Pilsen, Charles University, Pilsen, Czech Republic; fialao@fnplzen.cz.
In Vivo +

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February 26, 2025

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February 26, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

Serum total PSA (tPSA) and [-2]proPSA levels before treatment predict overall survival (OS) in metastatic castration-resistant prostate cancer (mCRPC) patients receiving androgen receptor-targeting agents (ARTA). Early PSA dynamics also show prognostic value.

Area Of Science

  • Oncology
  • Urology
  • Biomarkers

Background

  • Metastatic castration-resistant prostate cancer (mCRPC) is a significant clinical challenge.
  • New generation androgen receptor-targeting agents (ARTA) like abiraterone acetate (ABI) and enzalutamide (ENZ) have improved outcomes.
  • Prostate-specific antigen (PSA) and its isoforms are crucial serum biomarkers in prostate cancer management.

Purpose Of The Study

  • To investigate the prognostic significance of serum PSA isoforms and their early changes in mCRPC patients treated with ABI or ENZ.
  • To evaluate the predictive value of baseline and early dynamic changes in total PSA (tPSA), free PSA (fPSA), and [-2]proPSA for overall survival (OS).

Main Methods

  • Retrospective analysis of 334 mCRPC patients treated with ABI or ENZ.
  • Assessment of serum tPSA, fPSA, [-2]proPSA, and Prostate Health Index (PHI) at baseline and one month post-treatment.
  • Multivariable Cox proportional hazards models and Receiver Operating Characteristic (ROC) curve analyses were employed.

Main Results

  • Baseline tPSA >50 μg/l and [-2]proPSA >300 ng/l were independently associated with inferior OS.
  • Baseline fPSA >1.75 μg/l and a decrease in [-2]proPSA >-50% showed a trend towards significance.
  • ROC analysis indicated that baseline [-2]proPSA had the highest AUC (0.740) for predicting 2-year mortality, followed by tPSA (0.709).

Conclusions

  • Pretreatment serum levels of tPSA and [-2]proPSA are significant predictors of OS in mCRPC patients receiving ARTA.
  • These PSA isoforms hold prognostic value and can aid in risk stratification for patients undergoing ARTA treatment.

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