Prostate-specific Antigen Decline During Primary Androgen-deprivation Therapy for Predicting Response and Survival in Metastatic Castration-resistant Prostate Cancer Patients Receiving Enzalutamide.

Abstract

Background/aim: Currently, there are no established predictive or prognostic biomarkers for first-line enzalutamide (ENZ) treatment in patients with metastatic castration-resistant prostate cancer (mCRPC). This multicenter study aimed to assess the predictive and prognostic significance of the initial-to-nadir prostate-specific antigen (PSA) ratio (I/N PSA) during primary androgen-deprivation therapy for de novo metastatic castration-sensitive prostate cancer in relation to the response to first-line ENZ in mCRPC.

Patients and methods: A total of 33 patients with mCRPC receiving first-line enzalutamide were included in the study to investigate the correlation between I/N PSA in combined androgen blockade and clinical outcomes. Patients were dichotomized by median I/N PSA values. A PSA response was defined as a 90% or greater decline in PSA levels following the initiation of ENZ treatment in patients with mCRPC.

Results: The median I/N PSA was 382. In the high I/N PSA (≥382) group, the PSA response rate was 75.0%, significantly higher than that in the low I/N PSA group (35.3%; p=0.037). The median overall survival following ENZ treatment was significantly better in the high I/N PSA group than in the low group (p≤0.01). Multivariable analysis demonstrated I/N PSA as an independent predictor of overall survival (hazard ratio=0.20; p≤0.01).

Conclusion: In patients with mCRPC, the I/N PSA is a promising predictive and prognostic biomarker for first-line ENZ treatment and may provide personalized approaches in daily practice.