Prognostic outcomes in Japanese patients with metastatic castration-sensitive prostate cancer: Comparative assessments between conventional androgen deprivation therapy (ADT) and ADT with novel androgen receptor signal inhibitor

Hiromitsu Watanabe; Keita Nakane; Kiyoshi Takahara; Taku Naiki; Takahiro Yasui; Ryoichi Shiroki; Takuya Koie; Hideaki Miyake

doi:10.1111/iju.15498

Prognostic outcomes in Japanese patients with metastatic castration-sensitive prostate cancer: Comparative assessments between conventional androgen deprivation therapy (ADT) and ADT with novel androgen receptor signal inhibitor

Int J Urol. 2024 May 19. doi: 10.1111/iju.15498. Online ahead of print.

Authors

Hiromitsu Watanabe¹, Keita Nakane², Kiyoshi Takahara³, Taku Naiki⁴, Takahiro Yasui⁴, Ryoichi Shiroki³, Takuya Koie², Hideaki Miyake¹

Affiliations

¹ Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
² Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan.
³ Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan.
⁴ Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.

PMID: 38764245
DOI: 10.1111/iju.15498

Abstract

Objective: The objective of this study was to compare the prognostic outcomes between metastatic castration-sensitive prostate cancer (mCSPC) patients receiving conventional androgen deprivation therapy (ADT) and those receiving ADT plus a novel androgen-receptor signaling inhibitor (ARSI) in routine clinical practice in Japan.

Methods: This was conducted as a retrospective multicenter study including 581 mCSPC patients, consisting of 305 receiving ADT alone or in combination with bicalutamide (group 1) and 276 receiving ADT plus one of the following ARSIs: abiraterone acetate, apalutamide, or enzalutamide (group 2). Prognostic outcomes between these 2 groups were comprehensively compared.

Results: In the entire cohort, prostate-specific antigen-progression-free survival (PSA-PFS) in group 2 was significantly longer than that in group 1, while no significant difference was noted in overall survival (OS) between the two groups. In patients corresponding to the LATITUDE high-risk group, however, both PSA-PFS and OS in group 2 were significantly longer than those in group 1. Of several factors examined, the following were identified as independent predictors of poor PSA-PFS in the entire cohort as well as the LATITUDE high-risk group: high C-reactive protein, high lactate dehydrogenase, high alkaline phosphatase, high Gleason score, and group 1. Furthermore, it was possible to precisely classify both the entire cohort and LATITUDE high-risk group into 3 risk groups regarding PSA-PFS according to the positive numbers of independent factors: positive for ≤1 factor, favorable; 2 factors, intermediate; and ≥3 factors, poor.

Conclusion: Combined use of ARSIs with ADT could improve the prognostic outcomes of mCSPC patients, particularly those in the LATITUDE high-risk group, in real-world clinical practice in Japan.

Keywords: metastatic castration‐sensitive prostate cancer; novel androgen receptor signal inhibitor; real‐world outcome.