The Prognostic Significance of Radiographic Progression Without PSA Progression in Patients With Metastatic...

Area of Science:

• Oncology
• Urology
• Medical Imaging

Background:

• Radiographic progression (RP) without prostate-specific antigen (PSA) elevation is a significant pattern in metastatic hormone-sensitive prostate cancer (mHSPC) during androgen receptor pathway inhibitors (ARPI) treatment.
• The prevalence and prognostic impact of RP alone progression in real-world mHSPC cohorts are not well-defined.

Purpose of the Study:

• To determine the frequency of RP alone progression in mHSPC patients receiving first-line ARPIs.
• To evaluate the prognostic significance of RP alone progression on patient outcomes.

Main Methods:

• Retrospective analysis of 518 mHSPC patients treated with first-line abiraterone acetate plus prednisolone, enzalutamide, or apalutamide.
• Patients were classified based on PSA progression (PCWG3 criteria) or RP alone progression.
• Clinical outcomes, including overall survival, were compared between groups.

Main Results:

• Among 169 patients progressing to castration-resistant prostate cancer (CRPC), 34 (20.1%) showed RP alone progression.
• RP alone progression was linked to significantly worse overall survival (21 vs. 39 months, p=0.007) compared to PSA progression.
• High-volume disease (CHAARTED classification) was a key differentiator, being more prevalent in the RP alone group (94.1%) and identified as an independent risk factor.

Conclusions:

• RP alone progression affects approximately one-fifth of mHSPC patients and is associated with poorer survival outcomes.
• This pattern emerges despite favorable PSA responses, indicating limitations of PSA monitoring alone.
• Routine imaging is recommended for early detection of PSA-incongruent disease progression in mHSPC.