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. 2024 Jul 26;16(15):2659.
doi: 10.3390/cancers16152659.

Clinical Outcomes and Prognostic Factors in Nonmetastatic Castration-Resistant Prostate Cancer Treated with Androgen Receptor Signaling Inhibitors Therapy

Ryo Fujiwara  1 , Shinya Yamamoto  1 , Kosuke Takemura  1 , Takeshi Yuasa  1 , Noboru Numao  1 , Tomohiko Oguchi  1 , Yosuke Yasuda  1 , Yusuke Yoneoka  1 , Junji Yonese  1
Affiliations

Clinical Outcomes and Prognostic Factors in Nonmetastatic Castration-Resistant Prostate Cancer Treated with Androgen Receptor Signaling Inhibitors Therapy

Ryo Fujiwara et al. Cancers (Basel). .

Abstract

We conducted a retrospective evaluation of the clinical outcomes and prognostic factors in patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) treated with first-line androgen receptor signaling inhibitors (ARSI) in real-world clinical practice in Japan. Between 2012 and 2023, a total of 127 consecutive patients with nmCRPC received ARSI treatment. Overall survival (OS), metastatic-free survival (MFS), and prostate-specific antigen-progression-free survival (PSA-PFS) from ARSI initiation were assessed using the Kaplan-Meier methodology. Clinical factors associated with OS in nmCRPC were analyzed using the Cox proportional hazards model. Among the patients, 72, 26, 12, and 17 received enzalutamide (ENZ), abiraterone (ABI), apalutamide (APA), and darolutamide (DARO) as first-line therapy. The median OS and MFS for all patients were 79.0 and 42.0 months, respectively. Median PSA-PFS was 27.0, 20.0, 10.0, and 14.0 months for patients treated with ENZ, ABI, APA, and DARO, respectively (p = 0.33). Multivariate analysis revealed that a baseline PSA level ≥ 3.67 ng/mL at ARSI initiation was significantly associated with poorer OS (p = 0.002). ARSI demonstrated favorable efficacy in nmCRPC patients. There were no significant differences in clinical outcomes among different types of ARSI therapy for nmCRP. Elevated baseline PSA at ARSI initiation was significantly associated with poorer OS.

Keywords: androgen receptor signaling inhibitors; nonmetastatic castration-resistant prostate cancer; overall survival; prostate-specific antigen; real-world clinical practice.

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Conflict of interest statement

R. Fujiwara and T. Yuasa received remuneration for a lecture from Janssen Pharmaceutical K.K. (Tokyo, Japan). T. Yuasa received remuneration for a lecture from Astellas Pharma Inc. (Tokyo, Japan) and Bayer Pharma Japan (Tokyo, Japan). The other authors have declared no conflicts of interest.

Figures

Figure 1
Figure 1
PSA–PFS curve of ARSI for all patients after nmCRPC diagnosis was evaluated using the Kaplan–Meier method (n = 127).
Figure 2
Figure 2
Waterfall plots of the PSA response to ARSI (yellow: ENZ [n = 72], red: ABI [n = 26], green: APA [n = 12], blue: DARO [n = 17]).
Figure 3
Figure 3
PSA–PFS curve in nmCRPC patients divided by type of ARSI (yellow: ENZ [n = 72], red: ABI [n = 26], green: APA [n = 12], blue: DARO [n = 17]).
Figure 4
Figure 4
MFS curve of ARSI for all patients after nmCRPC diagnosis was evaluated using the Kaplan–Meier method (n = 109).
Figure 5
Figure 5
OS curve of ARSI for all patients after nmCRPC diagnosis was evaluated using the Kaplan–Meier method (n = 127).
Figure 6
Figure 6
OS curves divided by baseline PSA at the initiation of ARSI ≥ 3.67 (n = 64) and <3.67 (n = 63) ng/mL (p = 0.002).
See this image and copyright information in PMC

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