Optimal timing for initiating androgen receptor signaling inhibitor therapy in patients with nonmetastatic castration-resistant prostate cancer: a multicenter collaborative study

We determined the optimal timing for initiating androgen receptor signaling inhibitor (ARSI) therapy in patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) and assessed its impact on oncological outcomes. This retrospective study included 145 nmCRPC patients who received enzalu...

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Published in:Japanese journal of clinical oncology 2024-10
Main Authors: Hara, Shuhei, Urabe, Fumihiko, Tashiro, Kojiro, Goto, Yuma, Iwamoto, Yuya, Ohtsuka, Takashi, Fukuokaya, Wataru, Imai, Yu, Iwatani, Kosuke, Atsuta, Mahito, Mori, Keiichiro, Igarashi, Taro, Aikawa, Koichi, Yanagisawa, Takafumi, Kimura, Shoji, Murakami, Masaya, Tsuzuki, Shunsuke, Yanada, Brendan A, Hata, Kenichi, Furuta, Akira, Yamada, Hiroki, Miki, Jun, Kimura, Takahiro
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container_title Japanese journal of clinical oncology
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creator Hara, Shuhei
Urabe, Fumihiko
Tashiro, Kojiro
Goto, Yuma
Iwamoto, Yuya
Ohtsuka, Takashi
Fukuokaya, Wataru
Imai, Yu
Iwatani, Kosuke
Atsuta, Mahito
Mori, Keiichiro
Igarashi, Taro
Aikawa, Koichi
Yanagisawa, Takafumi
Kimura, Shoji
Murakami, Masaya
Tsuzuki, Shunsuke
Yanada, Brendan A
Hata, Kenichi
Furuta, Akira
Yamada, Hiroki
Miki, Jun
Kimura, Takahiro
description We determined the optimal timing for initiating androgen receptor signaling inhibitor (ARSI) therapy in patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) and assessed its impact on oncological outcomes. This retrospective study included 145 nmCRPC patients who received enzalutamide, apalutamide or darolutamide at the Jikei University Hospital or its affiliated institutions between May 2014 and November 2022. Patients were stratified based on prostate-specific antigen (PSA) doubling time (PSADT) at CRPC diagnosis and PSA levels at ARSI initiation. Oncological outcomes, including progression-free survival (PFS), metastasis-free survival (MFS), cancer-specific survival and overall survival, were assessed using the Kaplan-Meier curve and Cox regression analysis. The median age of the patients was 73 (interquartile range [IQR]: 52-88) years, and the median follow-up duration was 36 (IQR: 2-104) months. The median PSA level at ARSI initiation was 5.4 (IQR: 2.2-48) ng/ml, and 44.8% of patients had a PSADT
doi_str_mv 10.1093/jjco/hyae146
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This retrospective study included 145 nmCRPC patients who received enzalutamide, apalutamide or darolutamide at the Jikei University Hospital or its affiliated institutions between May 2014 and November 2022. Patients were stratified based on prostate-specific antigen (PSA) doubling time (PSADT) at CRPC diagnosis and PSA levels at ARSI initiation. Oncological outcomes, including progression-free survival (PFS), metastasis-free survival (MFS), cancer-specific survival and overall survival, were assessed using the Kaplan-Meier curve and Cox regression analysis. The median age of the patients was 73 (interquartile range [IQR]: 52-88) years, and the median follow-up duration was 36 (IQR: 2-104) months. The median PSA level at ARSI initiation was 5.4 (IQR: 2.2-48) ng/ml, and 44.8% of patients had a PSADT &lt;3 months. Multivariate analysis revealed that PSADT and PSA levels at ARSI initiation were independent MFS predictors. Patients with a PSADT ≤3 months and a PSA level ≥5.4 ng/ml experienced significantly reduced PFS and MFS. Notably, ARSI initiation at a PSA level ≥5.4 ng/ml was associated with worse outcomes, suggesting the potential benefit of earlier intervention. Patients with rapid PSADT are at increased risk of early disease progression, suggesting that immediate treatment may be warranted. In addition, initiating therapy at a PSA level &lt;5.4 ng/ml may be associated with improved patient outcomes in patients with low PSADT.</description><identifier>ISSN: 1465-3621</identifier><identifier>EISSN: 1465-3621</identifier><identifier>DOI: 10.1093/jjco/hyae146</identifier><identifier>PMID: 39426804</identifier><language>eng</language><publisher>England</publisher><ispartof>Japanese journal of clinical oncology, 2024-10</ispartof><rights>The Author(s) 2024. Published by Oxford University Press. All rights reserved. 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Patients with a PSADT ≤3 months and a PSA level ≥5.4 ng/ml experienced significantly reduced PFS and MFS. Notably, ARSI initiation at a PSA level ≥5.4 ng/ml was associated with worse outcomes, suggesting the potential benefit of earlier intervention. Patients with rapid PSADT are at increased risk of early disease progression, suggesting that immediate treatment may be warranted. In addition, initiating therapy at a PSA level &lt;5.4 ng/ml may be associated with improved patient outcomes in patients with low PSADT.</abstract><cop>England</cop><pmid>39426804</pmid><doi>10.1093/jjco/hyae146</doi><orcidid>https://orcid.org/0000-0002-2599-8183</orcidid><orcidid>https://orcid.org/0000-0001-6164-4684</orcidid></addata></record>
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title Optimal timing for initiating androgen receptor signaling inhibitor therapy in patients with nonmetastatic castration-resistant prostate cancer: a multicenter collaborative study
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