Androgen receptor-signaling inhibitors (ARSIs) have significantly changed the preferred treatments for metastatic castration-sensitive prostate cancer (mCSPC). Despite such advances, the prognostic significance of metastases at specific sites remains unclear.
This study evaluated how metastatic site affected the oncological outcomes of mCSPC patients.
This retrospective multicenter study included 716 mCSPC patients receiving androgen- deprivation therapy (ADT) alone, combined androgen blockade (CAB) therapy, or both ARSI and ADT (ARSI doublet) from February 2018 to June 2023. All patients were categorized based on their metastatic sites. The primary endpoint was the time to castration-resistant prostate cancer (CRPC) development; the secondary endpoints were progression-free survival 2 (PFS2), cancer-specific survival (CSS), and overall survival (OS). Kaplan-Meier curves and multivariate Cox's regression models were used to analyze the survival outcomes. We stratified mCSPC patients with bone metastases by the volumes of such metastases and lung metastasis status, and explored the clinical significance of lung metastasis.
Patients with lung-only metastases experienced better outcomes than those with other visceral metastases. On multivariate analysis, the bone metastasis volume, but not lung metastasis status, significantly affected CRPC-free survival status. No significant difference in any of CRPC, PFS2, CSS, or OS status was apparent among patients with bone metastases with or without lung metastases. In terms of interaction, lung metastasis did not significantly affect the prognoses of patients with either low- or high-volume bone metastases.
In the present era of ARSI doublet therapy, lung-only metastases in mCSPC patients were associated with favorable outcomes. The negative prognostic effects of lung metastases were much lower than was the bone metastasis volume, indicating that treatments targeting low-volume disease may be adequate even when lung metastases are apparent.
Urologic oncology. 2025 Feb 28 [Epub ahead of print]
Fumihiko Urabe, Kojiro Tashiro, Katsuki Muramoto, Takafumi Yanagisawa, Kota Katsumi, Hidetsugu Takahashi, Shuhei Hara, Wataru Fukuokaya, Yu Imai, Kosuke Iwatani, Mahito Atsuta, Keiichiro Mori, Taro Igarashi, Shoji Kimura, Masaya Murakami, Shunsuke Tsuzuki, Takaya Sasaki, Tatsuya Shimomura, Jun Miki, Takahiro Kimura, JIKEI-YAYOI Collaborative Group
Department of Urology, Jikei University School of Medicine, Tokyo, Japan. Electronic address: ., Department of Urology, Jikei University School of Medicine, Tokyo, Japan; Department of Urology, Jikei Katsushika Medical Center, Tokyo, Japan., Department of Urology, Jikei University School of Medicine, Tokyo, Japan., Department of Urology, Jikei University School of Medicine, Tokyo, Japan; Department of Urology, Jikei Kashiwa Hospital, Chiba, Japan., Department of Urology, Jikei University School of Medicine, Tokyo, Japan; Toneri Urology Clinic, Tokyo, Japan., Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/40023743