Androgen receptor signaling inhibitors (ARSI) and docetaxel (DTX) are standard treatments for metastatic castration-resistant prostate cancer (mCRPC). However, the differences in therapeutic efficacy between these treatments for mCRPC after upfront ARSI for metastatic castration-sensitive prostate cancer (mCSPC) remain unclear. In this study, we used real-world data to compare treatment efficacy and to identify prognostic indicators.
We retrospectively analyzed 120 patients who progressed to mCRPC after receiving ARSI as a first-line therapy for mCSPC. Second-line progression-free survival (PFS) and second-line overall survival (OS) were compared between the DTX and non-DTX groups. Cox proportional hazards regression analysis was performed to identify the prognostic indicators of second-line OS in patients with mCRPC. Propensity score matching was used to adjust for differences in baseline clinical characteristics.
Among matched patients with mCRPC, no significant differences were observed in second-line PFS or OS between the non-DTX and DTX groups. Univariate and multivariate analyses demonstrated that pretreatment serum lactate dehydrogenase (LDH) levels (<220 vs. ≥220 U/l) and Gleason pattern 5 (GP5) status were significant prognostic indicators for second-line OS in patients with mCRPC.
Pretreatment LDH levels and GP5 status may be useful prognostic indicators for patients with mCRPC following upfront ARSI therapy for mCSPC.
Japanese journal of clinical oncology. 2026 Jul 03 [Epub ahead of print]
Keita Hayakawa, Takashi Ueda, Yusuke Gabata, Junki Murashita, Hikaru Takahashi, Yumiko Saito, Masatsugu Miyashita, Takumi Shiraishi, Atsuko Fujihara, Masayoshi Okumi, Fumiya Hongo, Osamu Ukimura
Department of Urology, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto-City, Kyoto 602-8566, Japan.