Prostate-specific Antigen Response as a Prognostic Factor for Overall Survival in Patients with Prostate Cancer Treated with Androgen Receptor Pathway Inhibitors: A Systematic Review and Meta-analysis
- Marcin Miszczyk 1, Tamás Fazekas 2, Paweł Rajwa 3, Akihiro Matsukawa 4, Ichiro Tsuboi 5, Michael S Leapman 6, Gero Kramer 7, Maha Hussain 8, Axel Merseburger 9, Alberto Briganti 10, Anthony V D'Amico 11, Silke Gillessen 12, Fred Saad 13, Shahrokh F Shariat 14
- Marcin Miszczyk 1, Tamás Fazekas 2, Paweł Rajwa 3
- 1Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Collegium Medicum, Faculty of Medicine, WSB University, Dąbrowa Górnicza, Poland.
- 2Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Semmelweis University, Budapest, Hungary.
- 3Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Division of Surgery and Interventional Sciences, University College London, London, UK; Second Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland.
- 4Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Jikei University School of Medicine, Tokyo, Japan.
- 5Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Shimane University Faculty of Medicine, Shimane, Japan; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
- 6Department of Urology, Yale University School of Medicine, New Haven, CT, USA.
- 7Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
- 8Division of Hematology/Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- 9Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
- 10Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.
- 11Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA, USA.
- 12Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; Faculty of Biosciences, Università della Svizzera Italiana, Lugano, Switzerland.
- 13Department of Surgery/Urology, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Canada.
- 14Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czechia; Division of Urology, Department of Special Surgery, University of Jordan, Amman, Jordan; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA; Research Centre for Evidence Medicine, Urology Department, Tabriz University of Medical Sciences, Tabriz, Iran.
- 0Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Collegium Medicum, Faculty of Medicine, WSB University, Dąbrowa Górnicza, Poland.
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View abstract on PubMed
Summary
This summary is machine-generated.Prostate-specific antigen (PSA) decline predicts better survival for advanced prostate cancer patients on androgen deprivation therapy (ADT) plus androgen receptor pathway inhibitors (ARPI). This PSA response can signal treatment effectiveness early.
Area Of Science
- Oncology
- Medical Biomarkers
- Prostate Cancer Research
Background
- Advanced prostate cancer (PC) treatment often involves androgen deprivation therapy (ADT) combined with androgen receptor pathway inhibitors (ARPI).
- Prostate-specific antigen (PSA) levels are monitored as a potential indicator of treatment response in these patients.
Purpose Of The Study
- To synthesize existing data on the association between PSA response and overall survival (OS).
- To evaluate the utility of PSA decline as an early biomarker for treatment efficacy in advanced PC.
Main Methods
- A systematic literature search was conducted across major databases (MEDLINE, Embase, Web of Science, Google Scholar) up to November 2024.
- Random-effects meta-analyses were performed to pool hazard ratios (HRs) from identified studies.
Main Results
- Analysis of 14 studies (8883 patients) showed significant associations between PSA response and improved OS across various PC stages.
- Specific PSA reductions (e.g., undetectable, ≥90%, ≥50%) were linked to better survival outcomes in metastatic hormone-sensitive, nonmetastatic castration-resistant, and metastatic castration-resistant PC.
- Limitations included heterogeneity in study designs and prior ADT use.
Conclusions
- PSA response following ADT + ARPI therapy is a significant predictor of OS in advanced prostate cancer.
- PSA response can serve as a valuable early indicator of treatment efficacy.
- Further research is needed to confirm if PSA response is a surrogate for OS or should guide clinical management.
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