Falling PSA levels found to predict longer survival in prostate cancer patients at high risk of metastases (Using enzalutamide)

Declines in prostate-specific antigen (PSA) level after treatment with enzalutamide predict improved survival rates in men with non-metastatic castration-resistant prostate cancer (nmCRPC).

PROSPER trial data used to explore enzalutamide's effects on PSA levels The researchers analyzed data from the PROSPER trial, published in 2018, which enrolled men with nmCRPC and rapidly rising PSA levels. Increases in PSA signal an increased risk that the cancer will spread, or metastasize, outside of the prostate gland. In patients with nmCRPC, rising PSA levels are often the first sign that the cancer is growing.

The 'castration-resistant' part of nmCRPC means that the cancer no longer responds to standard hormone therapy. The PROSPER trial was designed to evaluate the effects of enzalutamide.

Most patients had sharp reductions in PSA after enzalutamide treatment. More than 97% of men in the enzalutamide group had at least a 50% decrease in PSA. In 38% of patients, PSA levels decreased by at least 90%.

Greater declines in PSA linked to lower risk of metastases, longer survival The reduction in PSA levels with enzalutamide treatment was a strong predictor of eventual survival rates, the analysis showed. Median metastasis-free survival—reflecting how long the men survived without cancer spread—was 37 months in patients with a PSA decline of 90% or greater, compared to about 22 months in those whose PSA level decreased by less than 50%.

Overall survival time was also related to enzalutamide response, ranging from 41 months with less than a 50% decline in PSA to 54 months with a 90% decline or greater. For men who had a 90% decline or greater and a PSA nadir (low point) of 0.2 ng/mL or less, survival time increased to 64 months, with the median survival time "not reached"—meaning that longer follow-up would be needed to show the final overall survival benefit.

A PSA at or below 0.2 ng/mL while on enzalutamide had a currently unlimited median survival benefit, which, right now, is an unlimited/unknown number of years.

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2 posted on 02/13/2023 11:00:15 AM PST by ConservativeMind (Trump: Befuddling Democrats, Republicans, and the Media for the benefit of the US and all mankind.)

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