Survival outcomes of real world patients with metastatic hormone-sensitive prostate cancer who do not achieve optimal PSA response with intensified androgen deprivation therapy with docetaxel or androgen receptor pathway inhibitors.

Introduction: In patients with metastatic hormone-sensitive prostate cancer (mHSPC) undergoing intensified androgen deprivation therapy (ADT), not achieving an optimal PSA response, defined as PSA nadir >0.2 ng/ml (PSA _subOR ) has been associated with worse survival outcomes in clinical trials ^(1)(10)(11) . Here, we externally evaluate, the impact of optimal PSA response on survival outcomes in these patients and provide absolute PFS and OS measures in those with PSA _subOR in the context of ADT intensification in real world setting.
Methods: In this retrospective study, all consecutive patients with mHSPC who underwent intensified ADT treated at our institution, and whose outcomes data were available, were included. We classified patients based on their PSA nadir on treatment: those with a on treatment PSA _OR (PSA nadir ≤0.2 ng/ml) versus PSA _subOR .
Results: A total of 205 patients were eligible: 136 (66.3%) patients achieved PSA _OR versus 69 (33.7%) patients had PSA _subOR . Patients who experienced a PSA _OR had significantly improved PFS and OS from the start of intensified ADT versus who did not: PFS was not reached (NR) versus 11 months (hazard ratio (HR) 0.20, P < 0.001) and OS was NR versus 38.9 months (HR 0.21, P < 0.001). Survival outcomes were poor with PSA _subOR regardless of intensification with docetaxel or an ARPI (absolute PFS and OS measures for each group are provided in the text).
Conclusion: Our study is the first to explore the negative impact of PSA _subOR in patients with mHSPC undergoing intensified ADT in the real-world setting, and is the first to provide absolute PFS and OS in patients with PSA _subOR receiving ADT intensification with ARPIs or docetaxel outside of clinical trial setting. These data will aid with prognostication, patient counseling, and for designing future clinical trials for patients with PSA _subOR .
(© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)