Hiroshige Tasuku, Suekane Hiroki, Tokunaga Takaho, Uegaki Mami, Iwashita Masahito, Taura Hiroki, Hirano Taishi, Mitani Tomotaro, Matsuo Mitsunori, Igawa Tsukasa
Department of Urology, St. Mary's Hospital, Kurume, Japan
Department of Urology, Kurume University School of Medicine, Kurume, Japan.
Anticancer Res. 2025 Feb;45(2):751-759. doi: 10.21873/anticanres.17463.
BACKGROUND/AIM: The prognostic significance of prostate-specific antigen (PSA) kinetics in metastatic castration-sensitive prostate cancer (mCSPC) patients treated with upfront therapy remains unclear. This study investigated the correlation between early PSA response and clinical outcomes in patients with mCSPC who received upfront therapy.
We analyzed 106 patients with mCSPC who received upfront therapies [abiraterone acetate (ABI), enzalutamide (ENZ), apalutamide (APA), and docetaxel (DOC)] at Kurume University Hospital and its affiliated hospitals.
Thirty-nine, 15, 38, and 14 patients were treated with ABI, DOC, ENZ, and APA, respectively. Among the total number of patients, 67 met the criteria for high-volume disease. Additionally, 83 patients were categorized as high risk. Patients with a PSA decline rate of ≥90% at 4 and 12 weeks post-upfront therapies had a significantly longer time to develop CRPC than those with a PSA decline of <90%. PSA cutoff values >26 ng/ml at 4 weeks post-upfront therapies and a PSA decline rate of ≥90% at 12 weeks post-upfront therapies were independent predictors of poor prognosis. Furthermore, patients were stratified into three groups based on PSA levels at 4 weeks and PSA decline rate at 12 weeks.
A larger PSA decline within three months of initiating upfront therapy is significantly associated with a longer time to CRPC in patients with mCSPC treated with upfront therapy. A combination of early PSA kinetics can be used to stratify the risk of CRPC progression in patients with mCSPC treated with upfront therapies.
背景/目的：在接受一线治疗的转移性去势敏感性前列腺癌（mCSPC）患者中，前列腺特异性抗原（PSA）动力学的预后意义仍不明确。本研究调查了接受一线治疗的mCSPC患者早期PSA反应与临床结局之间的相关性。
我们分析了在久留米大学医院及其附属医院接受一线治疗[醋酸阿比特龙（ABI）、恩杂鲁胺（ENZ）、阿帕他胺（APA）和多西他赛（DOC）]的106例mCSPC患者。
分别有39例、15例、38例和14例患者接受了ABI、DOC、ENZ和APA治疗。在所有患者中，67例符合高肿瘤负荷疾病标准。此外，83例患者被归类为高危患者。一线治疗后4周和12周时PSA下降率≥90%的患者发生去势抵抗性前列腺癌（CRPC）的时间明显长于PSA下降率<90%的患者。一线治疗后4周时PSA临界值>26 ng/ml以及一线治疗后12周时PSA下降率≥90%是预后不良的独立预测因素。此外，根据4周时的PSA水平和12周时的PSA下降率将患者分为三组。
在接受一线治疗的mCSPC患者中，开始一线治疗后三个月内PSA下降幅度更大与发生CRPC的时间更长显著相关。早期PSA动力学的组合可用于对接受一线治疗的mCSPC患者CRPC进展风险进行分层。
