Kapar Caner, Gulturk Ilkay, Tugcu Volkan, Sahin Selçuk, Guler Haydar, Kilickap Saadettin, Tural Deniz
Department of Medical Oncology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Dr Tevfik Sağlam Cd., No:11 Zuhuratbaba, Istanbul 34147, Turkey.
Department of Medical Oncology, Istanbul Research and Training Hospital, Istanbul, Turkey.
Ther Adv Med Oncol. 2025 Aug 27;17:17588359251369037. doi: 10.1177/17588359251369037. eCollection 2025.
Prostate-specific antigen (PSA) is widely used in the diagnosis and monitoring of prostate cancer. The prognostic relevance of very low PSA levels has not been clearly established in metastatic castration-sensitive prostate cancer (mCSPC). More sensitive PSA assays may provide more accurate estimates of clinical outcomes.
To evaluate the relationship between achieving very deep PSA levels (⩽0.02 ng/mL) within 6 months of treatment and radiologic progression-free survival (rPFS) in patients with mCSPC.
A retrospective, unicenter observational study conducted at a tertiary oncology center.
A total of 203 patients with mCSPC who received first-line treatment with luteinizing hormone-releasing hormone analogs, androgen receptor pathway inhibitors, or docetaxel were included. Patients were stratified into four groups based on their PSA nadir levels: ⩽0.02, 0.02-0.2, 0.2-4, and >4 ng/mL. Kaplan-Meier and Cox regression analyses were used to assess the association between PSA nadir and rPFS.
Patients achieving PSA ⩽ 0.02 ng/mL had significantly longer rPFS (median: 59.2 months) compared to other PSA groups. Multivariable analysis confirmed PSA ⩽ 0.02 ng/mL as an independent predictor of rPFS (HR: 2.02, < 0.001). The overall log-rank -value for group comparison was < 0.001.
A very deep PSA response (⩽0.02 ng/mL) is associated with longer rPFS and may serve as a prognostic marker in mCSPC. This threshold could be considered in future clinical trial design and treatment stratification.
前列腺特异性抗原（PSA）广泛应用于前列腺癌的诊断和监测。极低PSA水平在转移性去势敏感性前列腺癌（mCSPC）中的预后相关性尚未明确确立。更敏感的PSA检测可能会更准确地评估临床结局。
评估mCSPC患者在治疗6个月内达到极低PSA水平（≤0.02 ng/mL）与放射学无进展生存期（rPFS）之间的关系。
在一家三级肿瘤中心进行的回顾性单中心观察性研究。
共纳入203例接受促黄体生成素释放激素类似物、雄激素受体通路抑制剂或多西他赛一线治疗的mCSPC患者。根据PSA最低点水平将患者分为四组：≤0.02、0.02 - 0.2、0.2 - 4和>4 ng/mL。采用Kaplan-Meier和Cox回归分析评估PSA最低点与rPFS之间的关联。
与其他PSA组相比，PSA≤0.02 ng/mL的患者rPFS显著更长（中位数：59.2个月）。多变量分析证实PSA≤0.02 ng/mL是rPFS的独立预测因素（HR：2.02，P<0.001）。组间比较的总体对数秩检验P值<0.001。
极低的PSA反应（≤0.02 ng/mL）与更长的rPFS相关，可能作为mCSPC的预后标志物。在未来的临床试验设计和治疗分层中可考虑这一阈值。
