新診斷高風險轉移性的去勢敏感性前列腺癌治療結果的預測因素

江亭易¹、莊惠娟¹、李高漢¹、黃冠華¹、邱文祥²

¹外科部泌尿外科，奇美醫學中心；²泌尿外科，新光吳火獅紀念醫院

Predictive Factors for Treatment Outcomes in Metastatic Hormone-Sensitive Prostate Cancer

Ting-Yi Chiang¹、Chuan Hui Chuang¹、Kau-Han Lee¹、Steven K. Huang¹、Allen W.Chiu²

¹Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan; ²Department of Urology, Shin Kong Wu Ho-Su Memorial Hospital

Purpose:

To evaluate clinical factors influencing the efficacy of novel hormonal therapy (NHT) with androgen receptor pathway inhibitors (ARPi) in de novo metastatic hormone-sensitive prostate cancer (mHSPC) patients at high risk, focusing on 24-month outcomes.

Materials and Methods:

From January 2020 to May 2024, 85 de novo mHSPC patients treated at Chimei Medical Center were initially reviewed. Of these, 51 mHSPC patients treated with ARPi therapy. Patients were divided based on achieving 24-month treatment success or progressing to metastatic castration-resistant prostate cancer (mCRPC) within 24 months. Data collected included patient demographics, comorbidities, metastatic profiles, PSA and testosterone levels, as well as ARPi type. Univariate and multivariate Cox regression models were applied to identify predictors for treatment success and overall survival.

Results:

Of the 51 patients, 19 completed the 24-month ARPi treatment, while 32 experienced treatment failure. Patients who successfully completed 24 months of ARPi therapy demonstrated lower incidences of visceral metastasis (p=0.044), lower PSA nadir (p=0.021), and higher levels of testosterone suppression at 6 and 9 months (p=0.033, p=0.035). Multivariate analysis identified PSA response rates at 6 and 9 months, particularly >90% declines, as significant predictors for prolonged disease-free survival and overall survival (HR for 0-9 month PSA response >50% = 0.111, p<0.001). Bone metastasis in regions beyond the spine and pelvis was associated with higher risk of progression and poorer survival (HR for spine, pelvis = 1.341, p=0.039).

Conclusion:

ARPi efficacy in mHSPC is associated with early PSA declines, lower PSA nadir, and extent of bone metastasis. These findings may assist in optimizing treatment strategies for improved long-term outcomes in mHSPC patients.