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PSA Response as a Prognostic Marker in Metastatic Hormone-sensitive Prostate Cancer: Comparison with Tumor Volume
Rocío Martínez-Corral1, Pedro De Pablos-Rodríguez2, Sergio Antón-Fuente3
1Department of Urology, Complejo Hospitalario Universitario de Santiago de Compostela, University of Santiago de Compostela, A Coruña, Spain.
European Urology Open Science
|June 15, 2026
Summary
Prostate-specific antigen response (PSAr) at 6 months is a stronger predictor of survival in metastatic hormone-sensitive prostate cancer (mHSPC) than tumor volume alone. Achieving PSAr significantly reduces mortality risk compared to high tumor burden.
Area of Science:
- Oncology
- Prostate Cancer Research
- Clinical Prognostics
Background:
- Tumor volume and prostate-specific antigen response (PSAr) are key prognostic factors in metastatic hormone-sensitive prostate cancer (mHSPC).
- Comparative prognostic performance of these factors in mHSPC treated with doublet therapy remains unevaluated.
- Emerging data suggest PSAr may be more critical than tumor volume for patient outcomes.
Purpose of the Study:
- To compare the prognostic value of tumor volume versus 6-month PSAr for progression and mortality in mHSPC patients receiving doublet therapy.
- To assess the combined prognostic discrimination of tumor volume and PSAr.
Main Methods:
- Multicenter retrospective study involving 777 mHSPC patients treated with doublet therapy (2017-2025).
- Prostate-specific antigen response (PSAr) categorized as complete response (CR) or non-response (NR) at 6 months.
- Progression-free survival and overall survival analyzed using Kaplan-Meier estimates and multivariable Cox regression.
Main Results:
- Lack of PSAr strongly associated with increased mortality (HR 4.11), while high tumor volume showed a more modest association (HR 1.78).
- Patients with non-response (NR) and high-volume (HV) disease had the highest progression rates.
- Complete response (CR) in both low-volume (LV) and HV groups demonstrated substantially lower progression rates.
Conclusions:
- Six-month PSAr is a robust prognostic marker in mHSPC patients on doublet therapy, outperforming tumor volume alone.
- Failure to achieve early PSAr significantly elevates mortality risk compared to high tumor burden.
- Integrating PSAr with tumor volume enhances prognostic discrimination for mHSPC patients.
