Early Achievement of Ultra-low PSA Levels Correlates With Prolonged Radiologic Progression-free Survival (rPFS) in Metastatic Hormone-sensitive Prostate Cancer (mHSPC).

Authors

Deniz Tural, Fatih Kemik, Caner Kapar, Cevat İlteriş Kıkılı, Feyyaz Hazar Yağmur, Bahadır Köylü, Fatih Selçukbiricik

Published in

Clinical genitourinary cancer. Pages 102647. Aug 14, 2026. Epub Aug 14, 2026.

Abstract

Ultrasensitive assays enable detection of prostate-specific antigen (PSA) levels below 0.2 ng/mL, previously considered undetectable, allowing a more refined assessment of treatment response in metastatic hormone-sensitive prostate cancer (mHSPC). We evaluated the association between early achievement of ultra-low PSA levels and radiographic progression-free survival (rPFS).
Patients received first-line androgen deprivation therapy (ADT) alone, ADT plus docetaxel, or ADT combined with androgen receptor pathway inhibitors (ARPIs). PSA levels were measured at baseline and during the first 3 months. Patients were stratified according to the lowest PSA level achieved within 3 months: < 0.02 ng/mL, 0.02 to 0.2 ng/mL, and > 0.2 ng/mL. rPFS was estimated using the Kaplan-Meier method.
Of 347 patients, 323 were included in the analysis. Median age was 68 years, and 51.7% had ECOG performance status 0. High-volume disease was present in 50.5%, and 76.5% had synchronous metastases. Treatment included ADT alone (25.1%), ADT plus docetaxel (24.5%), and ARPI-based therapy (50.5%). Within 3 months, 15.5% achieved PSA < 0.02 ng/mL, 18.9% had PSA 0.02 to 0.2 ng/mL, and 65.6% had PSA > 0.2 ng/mL. Ultra-low PSA responses were more frequent with ARPI-based therapy (20.9%) compared with ADT alone (12.4%) and ADT plus docetaxel (7.6%). Median rPFS was 34.2 months (95% confidence interval, 27-40). Five-year rPFS rates were 89%, 80%, and 18% for PSA < 0.02, 0.02 to 0.2, and ≥ 0.2 ng/mL, respectively (P < .001).
Early achievement of ultra-low PSA (< 0.02 ng/mL within 3 months) is strongly associated with prolonged rPFS in mHSPC and may serve as a novel early surrogate marker of treatment efficacy.

PMID:
42702516
Bibliographic data and abstract were imported from PubMed on 07 Sep 2026.

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