Urologic oncology · 2026
Beyond PSA90: Deep PSA response predicts outcomes in nonmetastatic CRPC.
СтатьяНазвание и аннотация: Перевод в очереди
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Hara Shuhei, Mori Keiichiro, Yamaguchi Ryotaro, Yata Yuji, Kurawaki Shiro, Iwamoto Yuya, Kawano Shota, Otsuka Takashi, Fukuokaya Wataru, Miyajima Keiichiro, Ishikawa Mimu, Kurokawa Gaku, Imai Yu, Nakazono Minoru, Atsuta Mahito, Urabe Fumihiko, Yanagisawa Takafumi, Tsuzuki Shunsuke, Shimomura Tatsuya, Yamada Hiroki, Kimura Takahiro
Аннотация
OBJECTIVES: To evaluate whether deeper prostate-specific antigen (PSA) decline adds prognostic information beyond the conventional 90% decline benchmark (PSA90) in nonmetastatic castration-resistant prostate cancer (nmCRPC).
PATIENTS AND METHODS: We retrospectively evaluated 349 patients with nmCRPC treated with first-line androgen receptor signalling inhibitors (ARSIs) at 16 Japanese institutions. To reduce immortal time bias, we used a 6-month landmark cohort (n = 263). Patients were grouped by maximum PSA decline within 6 months: <90% (Group A), 90% to 96% (Group B), and >96% (Group C). The primary endpoint was progression-free survival (PFS). Multivariable Cox models and restricted cubic spline analysis assessed the association between PSA decline and PFS. Exploratory multivariable logistic regression evaluated predictors of >96% PSA decline.
RESULTS: Compared with Group A, Group C had lower progression risk (adjusted hazard ratio [aHR] 0.22, 95% confidence interval [CI] 0.13-0.38; P < 0.001), and Group B also had lower risk (aHR 0.39, 95% CI: 0.19-0.79; P = 0.010). Spline analysis showed a continuous decrease in risk beyond the 90% threshold with no clear evidence of a plateau within the observed range. Higher baseline PSA independently predicted worse PFS (aHR 1.39, 95% CI: 1.12-1.72; P = 0.002). No baseline clinical factor significantly predicted achievement of >96% PSA decline in exploratory analysis.
CONCLUSION: In nmCRPC treated with first-line ARSI, deeper PSA response was continuously associated with improved PFS. An exploratory >96% PSA decline identified a subgroup with particularly favorable outcomes, but external validation is required.
PATIENTS AND METHODS: We retrospectively evaluated 349 patients with nmCRPC treated with first-line androgen receptor signalling inhibitors (ARSIs) at 16 Japanese institutions. To reduce immortal time bias, we used a 6-month landmark cohort (n = 263). Patients were grouped by maximum PSA decline within 6 months: <90% (Group A), 90% to 96% (Group B), and >96% (Group C). The primary endpoint was progression-free survival (PFS). Multivariable Cox models and restricted cubic spline analysis assessed the association between PSA decline and PFS. Exploratory multivariable logistic regression evaluated predictors of >96% PSA decline.
RESULTS: Compared with Group A, Group C had lower progression risk (adjusted hazard ratio [aHR] 0.22, 95% confidence interval [CI] 0.13-0.38; P < 0.001), and Group B also had lower risk (aHR 0.39, 95% CI: 0.19-0.79; P = 0.010). Spline analysis showed a continuous decrease in risk beyond the 90% threshold with no clear evidence of a plateau within the observed range. Higher baseline PSA independently predicted worse PFS (aHR 1.39, 95% CI: 1.12-1.72; P = 0.002). No baseline clinical factor significantly predicted achievement of >96% PSA decline in exploratory analysis.
CONCLUSION: In nmCRPC treated with first-line ARSI, deeper PSA response was continuously associated with improved PFS. An exploratory >96% PSA decline identified a subgroup with particularly favorable outcomes, but external validation is required.