This article (source linked below) investigates the significance of post-treatment prostate-specific antigen (PSA) kinetics, specifically nadir PSA (nPSA) and PSA-density (PSA-D), in forecasting survival outcomes for patients with high-volume metastatic hormone-sensitive prostate cancer (mHSPC) undergoing novel hormonal therapies. The study highlights the crucial role these biomarkers play in shaping personalized treatment strategies and enhancing patient care.

Recent advancements have transformed the treatment landscape for mHSPC. While androgen deprivation therapy (ADT) has traditionally been the primary treatment, the introduction of novel hormonal agents like abiraterone acetate and enzalutamide has revolutionized the approach. Combining these agents with ADT is now the preferred method for managing high-volume mHSPC. Despite these progressions, high-volume mHSPC remains a challenging condition with a high risk of progression and mortality. Therefore, identifying reliable prognostic biomarkers is essential for guiding treatment decisions and predicting patient outcomes.

PSA has long been a valuable biomarker in prostate cancer, used both for screening and monitoring treatment responses. This study emphasizes the prognostic value of PSA kinetics, including nPSA and PSA-D, across various clinical settings. In a cohort of 102 patients with high-volume mHSPC treated with novel hormonal therapies, the research found that lower nPSA (≤ 0.2 ng/mL) and PSA-D (≤ 0.08 ng/mL²) measured after initiating treatment were independently associated with improved progression-free survival (PFS) and overall survival (OS). Here, nPSA refers to the lowest PSA level achieved post-treatment, while PSA-D is calculated three months after treatment commencement. Importantly, the combined use of both markers provided greater predictive accuracy than either marker alone.

The study also underscores the negative prognostic impact of visceral metastases, particularly liver involvement. The presence of visceral metastases was identified as an independent risk factor for both PFS and OS, likely due to an increased likelihood of neuroendocrine differentiation in these metastases, which can lead to resistance to hormonal therapies. These findings suggest that patients with high-volume mHSPC and visceral metastases may require more aggressive treatment approaches, potentially including chemotherapy.

In conclusion, the study underscores the importance of integrating post-treatment PSA kinetics, specifically nPSA and PSA-D, into the clinical management of patients with high-volume mHSPC undergoing novel hormonal therapies. Monitoring these biomarkers after treatment initiation allows clinicians to identify high-risk individuals and adjust treatment plans accordingly to achieve better outcomes. Utilizing both nPSA and PSA-D enhances prognostic accuracy, enabling more precise risk stratification and personalized treatment strategies. These results support further research into PSA kinetics as a valuable tool for improving the care of patients with high-volume mHSPC.

Source.