Real-World Longitudinal Treatment Outcomes for Patients with Metastatic Castration-Sensitive Prostate Cancer in Japan.

Authors

Taketo Kawai, Fumiko Kiyonaga, Satoshi Uno, Hirotaka Shibata, Atsushi Saito

Published in

Advances in therapy. Sep 06, 2026. Epub Sep 06, 2026.

Abstract

With recent approvals in Japan, identifying optimal first-line therapy for metastatic castration-sensitive prostate cancer (mCSPC) is critical. We evaluated real-world outcomes of androgen-deprivation therapy (ADT) plus androgen receptor signaling inhibitors (ARSIs) as first-line therapies using prostate-specific antigen (PSA) responses and treatment duration.
This retrospective study used the Medical Data Vision database (May 2020-April 2024). The study population included males with mCSPC, with two cohorts: cohort 1 (with PSA data); cohort 2 (all eligible patients).
cumulative incidence of ≥ 90% PSA reduction (PSA90) during the first-line period. Secondary endpoints: PSA50; PSA ≤ 0.2 ng/mL; time to PSA progression (TTPP); time-to-treatment discontinuation (TTD). Endpoints were estimated using the Kaplan-Meier method evaluated using the Cox proportional hazards model, adjusted for baseline characteristics.
In cohort 1 (n = 1306), cumulative PSA90 response rates were higher with ADT + ARSI ± docetaxel (ARSI-based treatments) than with ADT alone or ADT + nonsteroidal antiandrogens (NSAAs) (at 3 months: ADT alone, 63.2%; ADT + NSAAs, 69.3%; ADT + enzalutamide, 91.8%; ADT + apalutamide, 90.9%; ADT + abiraterone, 90.7%; ADT + darolutamide + docetaxel, 81.2%). Cumulative PSA50 and PSA ≤ 0.2 ng/mL response rates were consistent with PSA90 findings. Median TTPP was longer for ARSI-based treatments versus ADT alone and ADT + NSAA. No significant differences were observed among ARSI-based treatments across these PSA-related endpoints. In cohort 2 (n = 11,737), the median TTD was longer for ARSI-based treatments versus ADT alone and ADT + NSAAs. Notably, ADT + apalutamide showed a shorter median TTD than other ARSI-based treatments.
Compared with ADT alone or ADT + NSAA, ARSI-based treatments showed faster PSA declines and longer treatment durations. While ARSI-based treatments demonstrated similar PSA-lowering effects, differences in treatment continuation likely reflect real-world clinical management influenced by not only PSA response but also adverse events and patient characteristics.

PMID:
42701987
Bibliographic data and abstract were imported from PubMed on 07 Sep 2026.

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