轉移性去勢敏感型攝護腺癌患者使用雄激素受體抑制劑:
單一醫院經驗分享

李宗翰¹、陳米妮¹、江長和¹、張延驊^1,2、黃志賢^1,2、鍾孝仁^1,2、

黃奕燊^1,2、魏子鈞^1,2、黃子豪^1,2、陳威任^1,2、黃逸修^1,2

¹臺北榮民總醫院泌尿部

²國立陽明交通大學醫學院泌尿學科 書田泌尿科學研究中心

Real-World Outcomes of Androgen Receptor Pathway Inhibitor Regimens in Treating Metastatic Castration-Sensitive Prostate Cancer: A Single-Center Experience

Tsung-Han Li¹, Minnie Chen¹, Chang-Ho Chiang¹, Yen-Hwa Chang^1,2,

William J.S. Huang^1,2, Hsiao-Jen Chung^1,2, I-Shen Huang^1,2, Tzu-Chun Wei^1,2,

Tzu-Hao Huang^1,2, Wei-Jen Chen^1,2, Eric Yi-Hsiu Huang^1,2

¹Department of Urology, Taipei Veterans General Hospital

²Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan

Purpose: Triplet (ADT + docetaxel + darolutamide) and ARPI-based doublets (ADT + abiraterone/apalutamide/enzalutamide) have transformed the management of high-risk metastatic castration-sensitive prostate cancer (mCSPC). However, comparative real-world data among these available ARPI-based regimens remain limited. This study aimed to compare real-world outcomes across four ARPI-based treatment regimens—triplet therapy and three ARPI doublets—in patients with high-risk mCSPC treated at our institution.

Methods: We retrospectively reviewed patients with high-risk mCSPC treated at a tertiary referral center between 2018 and 2025. Four treatment cohorts were analyzed: triplet (ADT + docetaxel + darolutamide, n = 29), abiraterone (ABI, n = 58), apalutamide (APA, n = 48), and enzalutamide (ENZA, n = 47). Clinical data included age, ECOG performance status, initial PSA (iPSA), Gleason grade group, metastatic pattern, PSA nadir, time to nadir, time to PSA 50 % decline, PSA and radiographic progression (rP), follow-up duration, adverse events (AEs), and survival outcomes.

Results: Baseline characteristics were comparable among the four cohorts. Median age was 73 years (IQR 66–79); 87 % had ECOG 0–1 and 82 % Gleason grade group ≥ 4. Bone metastases were present in all patients, and 23 % had visceral involvement. Median iPSA was 384 ng/mL (163–1418). Median follow-up duration was 21.0 months (IQR 11–38) for triplet, 24.0 (IQR 13.1–44.0) ABI, 15.8 (IQR 2–31) APA, and 17.0 (IQR 5.1–31.6) ENZA. PSA response rate (nadir ≤0.2 ng/mL) was 62.1% for triplet, 62.1% for ABI, 60.0% for APA, 59.6% for ENZA. Median time to PSA 50% decline was 1.3 (IQR 0.9–1.5) months for triplet, 0.8 (IQR 0.7–0.9) ABI, 1.8 (IQR 1.3–3.0) APA, 1.8 (IQR 0.9–3.0) ENZA. Estimated median PFS was 2.9 (IQR 2.5–3.7) months for triplet, 10.0 (IQR 8.0–20.0) ABI, 5.3 (IQR 3.9–6.8) APA, 2.9 (IQR 2.0–11.1) ENZA. Median OS was not reached in any group. Cancer-specific deaths occurred in 6 ABI patients (10.3 %), while all-cause mortality was 34.5 % for ABI and 18.8 % for APA. No treatment-related deaths were observed. AEs were mainly grade 1–2. Neutropenia (24%) occurred with triplet therapy, while anemia and hypertension (≈15–30%) were most frequent with ARPI doublets.

Conclusions: This real-world, single-center analysis demonstrated comparable PSA response rates, PFS, and tolerability among four ARPI-based regimens for high-risk mCSPC. Variations in PSA progression among individual ARPI treatments suggest potential differences in disease dynamics, warranting confirmation in larger, prospective cohorts. Longer follow-up is needed to clarify long-term survival outcomes and optimal sequencing of ARPI-based therapies.