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Updated: Jan 9, 2026

A Bioluminescent and Fluorescent Orthotopic Syngeneic Murine Model of Androgen-dependent and Castration-resistant Prostate Cancer
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Should Upfront Therapy With Androgen Receptor Signaling Inhibitors Be Used in All Japanese Patients With Metastatic

Kenta Onishi1, Yasushi Nakai1, Makito Miyake1

  • 1Department of Urology, Nara Medical University, Kashihara, Japan.

Anticancer Research
|November 29, 2025
PubMed
Summary

Upfront androgen receptor signaling inhibitors (ARSI) therapy for metastatic castration-sensitive prostate cancer (mCSPC) in Japanese patients delayed progression but did not improve overall survival compared to traditional treatments.

Keywords:
AndrogensJapanprogression-free survivalprostatic neoplasmstherapeutics

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Area of Science:

  • Oncology
  • Urology
  • Clinical Research

Background:

  • Metastatic castration-sensitive prostate cancer (mCSPC) treatment landscape is evolving.
  • Androgen receptor signaling inhibitors (ARSI) are a key therapeutic class.
  • Optimal sequencing of therapies for mCSPC remains under investigation.

Purpose of the Study:

  • To evaluate the efficacy and safety of upfront androgen receptor signaling inhibitors (ARSI) versus sequential therapy in Japanese patients with metastatic castration-sensitive prostate cancer (mCSPC).

Main Methods:

  • Retrospective analysis of the MAHOROBA database.
  • Comparison of upfront ARSI (Group A) versus vintage hormonal therapy followed by ARSI (Group B).
  • Propensity score matching (PSM) used to balance patient characteristics; adverse events, progression-free survival (PFS), and overall survival (OS) were compared.

Main Results:

  • Upfront ARSI (Group A) showed a significantly higher first PFS rate compared to vintage hormonal therapy (Group B).
  • No significant difference in overall survival (OS) was observed between the upfront ARSI and sequential therapy groups.
  • While upfront ARSI delayed time to castration-resistant prostate cancer (CRPC), the overall survival benefit was not demonstrated.

Conclusions:

  • Upfront ARSI therapy in Japanese mCSPC patients effectively delays progression to CRPC.
  • Current data suggest upfront ARSI does not confer an overall survival advantage over sequential therapy in this population.
  • Further research may be needed to refine treatment strategies and identify patient subgroups who benefit most from upfront ARSI.