Prostate-Specific Antigen Response as a Prognostic Factor for Overall Survival in Patients with Prostate Cancer Treated with Androgen Receptor Pathway Inhibitors - Beyond the Abstract
We found that PSA reduction thresholds such as ≥50% and ≥90% reduction, and achieving undetectable PSA, were significantly associated with improved overall survival (OS), with pooled hazard ratios between 0.22 and 0.39 depending on the disease setting and threshold. These effects persisted despite heterogeneity, e.g., regarding lead-in ADT duration (in mHSPC) and initial PSA levels, enabling clinically meaningful stratification of patients into those with favorable and poor prognoses.
In the context of advanced prostate cancer, these findings could be transformative. ADT+ARPI doublet is now considered the standard of care for mHSPC, but it is still not uncommon to see it in the first-line ARPC treatment setting. There are many new emerging treatments; however, complementary treatments layered on top of this doublet raise concerns about overtreatment. Dynamic assessment of treatment response, such as PSA decline, could identify patients with robust responses in whom it is not necessary to escalate treatment, and, on the contrary, who may benefit from treatment de-escalation. Conversely, identifying poorly responding patients with adverse prognoses could prompt early treatment escalation, potentially achieving deeper and more durable responses. Most importantly, PSA response is a powerful, cost-effective tool for personalizing treatment, which is widely available due to routine use of PSA for treatment-response monitoring, offering a great alternative to the more expensive and less accessible genetic prognostic tests.
Written by: Marcin Miszczyk, MD, PhD, and Shahrokh F. Shariat, MD
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
Read the Abstract