PSA suppression predicts prognosis in high-risk mHSPC

By Agata Buczak

A retrospective single‑center analysis published in the Asian Journal of Andrology, reports that deeper prostate-specific antigen (PSA) suppression is associated with longer PSA progression‑free survival (PSA‑PFS), radiographic PFS (rPFS), and overall survival (OS) in patients with high‑risk metastatic hormone‑sensitive prostate cancer (mHSPC). PSA kinetics are routinely used to monitor treatment response in mHSPC, and the study examined how specific PSA decline patterns related to clinical outcomes.

Qian Wang (Institute of Urology, West China Hospital, Sichuan University, Chengdu, China) and colleagues evaluated 153 patients with mHSPC treated with androgen‑deprivation therapy plus abiraterone. The analysis assessed the prognostic relevance of PSA nadir depth and duration over a median follow‑up of 31.3 months.

The researchers compared survival outcomes across predefined PSA nadir categories by stratifying patients into three groups: <0.2 ng/mL (n=85), 0.2–<4 ng/mL (n=48), and ≥4 ng/mL (n=20). Those achieving a nadir <0.2 ng/mL had substantially longer PSA-PFS, rPFS, and OS, with median PSA-PFS of 51.0 months compared with 18.5 and 6.9 months in the higher groups.

Within the <0.2 ng/mL subgroup, both the timing and durability of suppression were prognostic. Reaching <0.2 ng/mL within 6 months was associated with improved PSA‑PFS and rPFS compared with those who reached this level later, and patients who maintained <0.2 ng/mL for ≥10 months had substantially prolonged survival (PSA‑PFS of 56.7 vs 19.3 months).

Multivariable analyses showed that achieving <0.2 ng/mL within 6 months and maintaining suppression for ≥10 months were independent prognostic factors within this subgroup.

Several baseline characteristics, including age ≥75 years, low baseline hemoglobin, high‑volume tumor burden, and intraductal carcinoma, were also associated with poorer outcomes on selected endpoints. The authors note the retrospective, single-center design and highlight the need for validation in larger cohorts. They conclude that “continuous PSA improvement is an important prognostic indicator, and the speed, depth, and duration of PSA decline are key independent factors influencing prognosis.” 

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