Full-Component Chart-Derived Lee Score, Upfront Androgen Receptor Signaling Inhibitor Selection, and Competing...

To examine associations of a full-component chart-derived Lee score with upfront androgen receptor signaling inhibitor (ARSI) selection and competing mortality in men with metastatic hormone-sensitive prostate cancer (mHSPC).

Of 136 potentially eligible patients receiving docetaxel-free first-line therapy, 96 with direct pretreatment documentation of all four functional items were included. The 12-component score used the original point allocations and was analyzed continuously. Upfront ARSI receipt was evaluated using adjusted Firth logistic regression. Other-cause mortality was assessed using univariable cause-specific Cox and Fine-Gray models.

Thirty-three patients (34.4%) received upfront ARSI. Median age was 80 years and median score was 11. In the adjusted model (n = 91), a higher score showed an uncertain inverse association with upfront ARSI receipt (odds ratio per point, 0.84; 95% confidence interval [CI], 0.69-1.01; p = 0.066). The reverse Kaplan-Meier estimate of median follow-up was 37 months. Twenty-nine deaths occurred, including 17 from other causes. In univariable Cox analysis, a higher score was associated with other-cause death (hazard ratio per point, 1.16; 95% CI, 1.02-1.32; p = 0.028), with a similar Fine-Gray estimate. Forty patients were excluded for incomplete functional documentation; included and excluded patients differed in age, albumin, ARSI use, and observed follow-up.

The score showed a possible inverse relation with treatment intensification and was associated with other-cause mortality. Because the analysis used an item-complete subset with few competing events, the findings are exploratory. Direct functional assessment should inform treatment individualization.