Prostate-specific Antigen Response as a Prognostic Factor for Overall Survival in Patients with Prostate Cancer Treated with Androgen Receptor Pathway Inhibitors: A Systematic Review and Meta-analysis.

IF 4.8 2区医学 Q1 UROLOGY & NEPHROLOGY

European urology focus Pub Date : 2025-05-15 DOI:10.1016/j.euf.2025.03.019

Marcin Miszczyk, Tamás Fazekas, Paweł Rajwa, Akihiro Matsukawa, Ichiro Tsuboi, Michael S Leapman, Gero Kramer, Maha Hussain, Axel Merseburger, Alberto Briganti, Anthony V D'Amico, Silke Gillessen, Fred Saad, Shahrokh F Shariat

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引用次数: 0

Abstract

Background and objective: For patients with advanced prostate cancer (PC) treated with androgen deprivation therapy (ADT) plus an androgen receptor pathway inhibitor (ARPI), the decline in prostate-specific antigen (PSA) is a potential biomarker for treatment response. We synthesised data regarding the association of the PSA response with overall survival (OS).

Methods: The MEDLINE, Embase, Web of Science, and Google Scholar databases were searched up to November 2024 to identify studies evaluating the association between the PSA response and OS among patients treated with ADT + ARPI. Hazard ratios (HRs) were pooled in random-effects meta-analyses.

Key findings and limitations: We identified 14 studies comprising a total of 8883 patients. Among four studies in metastatic hormone-sensitive PC (n = 2197), achievement of an undetectable PSA level was associated with better OS (HR 0.33, 95% confidence interval [CI] 0.23-0.49). In two studies in nonmetastatic castration-resistant PC (n = 1507), a PSA decline to <0.2 ng/ml (HR 0.28, 95% CI 0.21-0.36), a PSA reduction of ≥90% (HR 0.39, 95% CI 0.28-0.52), and a PSA reduction of ≥50% (HR 0.34, 95% CI 0.16-0.69) were associated with better OS. Among four studies in metastatic castration-resistant PC (n = 3728), PSA reductions of ≥90% (HR 0.22, 95% CI 0.14-0.34) and ≥50% (HR 0.29, 95% CI 0.20-0.41) were associated with better OS. The main limitations include heterogeneity in study designs and use of ADT before baseline PSA measurement in mHSPC studies.

Conclusions and clinical implications: The PSA response following ADT + ARPI therapy is significantly associated with OS across all metastatic and castration-resistant PC states and could serve as a clinically useful early signal of efficacy. It remains to be proven whether the PSA response is a surrogate for OS or should guide changes in clinical care.

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前列腺特异性抗原反应作为雄激素受体途径抑制剂治疗前列腺癌患者总生存率的预后因素：一项系统综述和荟萃分析

背景与目的：对于接受雄激素剥夺疗法（ADT）联合雄激素受体途径抑制剂（ARPI）治疗的晚期前列腺癌（PC）患者，前列腺特异性抗原（PSA）的下降是治疗反应的潜在生物标志物。我们综合了PSA反应与总生存期（OS）相关的数据。方法：检索截至2024年11月的MEDLINE、Embase、Web of Science和谷歌Scholar数据库，以确定评估ADT + ARPI治疗患者PSA反应与OS之间关系的研究。在随机效应荟萃分析中汇总风险比（hr）。主要发现和局限性：我们纳入了14项研究，共纳入8883名患者。在4项关于转移性激素敏感PC的研究中（n = 2197）， PSA检测不到的水平与更好的OS相关（HR 0.33, 95%可信区间[CI] 0.23-0.49）。在两项针对非转移性去势抵抗性PC （n = 1507）的研究中，PSA下降得出结论和临床意义：在所有转移性和去势抵抗性PC状态下，ADT + ARPI治疗后的PSA反应与OS显著相关，可以作为临床有用的疗效早期信号。PSA反应是否是OS的替代指标，还是应该指导临床护理的变化，还有待证实。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European urology focus Medicine-Urology

CiteScore

10.40

自引率

3.70%

发文量

274

审稿时长

23 days

期刊介绍： European Urology Focus is a new sister journal to European Urology and an official publication of the European Association of Urology (EAU). EU Focus will publish original articles, opinion piece editorials and topical reviews on a wide range of urological issues such as oncology, functional urology, reconstructive urology, laparoscopy, robotic surgery, endourology, female urology, andrology, paediatric urology and sexual medicine. The editorial team welcome basic and translational research articles in the field of urological diseases. Authors may be solicited by the Editor directly. All submitted manuscripts will be peer-reviewed by a panel of experts before being considered for publication.