Early PSA Decline Predicts Survival Outcomes in Metastatic Castration-Resistant Prostate Cancer Treated with Androgen...

Area of Science:

• Oncology
• Urology
• Pharmacology

Background:

• Metastatic castration-resistant prostate cancer (mCRPC) is heterogeneous, posing challenges in identifying patients with limited response to androgen receptor pathway inhibitors (ARPIs).
• Prostate-specific antigen (PSA) kinetics offer a potential early indicator of treatment efficacy.
• Timely identification of non-responders to ARPIs like abiraterone acetate and enzalutamide is crucial for optimizing patient management.

Purpose of the Study:

• To evaluate the prognostic value of a ≥50% PSA reduction at three months in mCRPC patients treated with ARPIs in a real-world setting.
• To determine if early PSA kinetics can predict progression-free survival (PFS) and overall survival (OS).

Main Methods:

• Retrospective single-center study including 60 mCRPC patients treated with abiraterone acetate or enzalutamide.
• Stratification based on PSA decline at three months (≥50% vs. <50%).
• Kaplan-Meier analysis for PFS and OS, with log-rank tests and Cox proportional hazards models for prognostic variable assessment.

Main Results:

• 73.3% of patients achieved a ≥50% PSA decline at three months.
• Patients with ≥50% PSA decline demonstrated significantly longer PFS and OS compared to those with <50% decline.
• Multivariate analysis confirmed early PSA decline as a significant predictor of improved survival outcomes.

Conclusions:

• A ≥50% PSA reduction by three months is a simple, clinically relevant marker for treatment response in mCRPC patients receiving ARPIs.
• Early PSA kinetics can facilitate prompt risk stratification and enhanced clinical monitoring in routine practice.
• This finding supports the use of early PSA response to guide treatment decisions and patient follow-up strategies.