本研究的目的是评估紫杉烷难治性转移性去势抵抗性前列腺癌 (mCRPC) 患者开始第二代激素治疗 (2nd HT)（即醋酸阿比特龙或恩杂鲁胺）后早期 PSA 下降的预后价值评估该指标在强化监测/影像学方案中的效用。我们回顾性地确定了 75 名 mCRPC 患者，他们在多西紫杉醇失败（定义为 PSA 升高和影像学进展）后接受了第二次 HT 治疗。根据治疗开始后 3 个月内首次 PSA 将患者分为两组：PSA 降低≥50%（A 组）和 PSA 降低<50%（B 组）。主要终点是癌症特异性死亡率（CSM）。次要终点是第二次 HT 时的影像学疾病进展 (rDP)。在单变量和多变量分析中，我们调查了与 rPD 和 CSM 相关的因素。我们在分析队列中纳入了 75 名患者（A 组 52 名，B 组 23 名）。两组之间的基线临床人口统计学特征，包括中位年龄、主要格里森评分风险组、中位治疗前PSA、疾病负担、转移部位和治疗前ECOG评分没有统计学差异。 A 组和 B 组的中位随访时间为 30 个月，放射学疾病进展的中位时间分别为 28.1 个月和 12.5 个月 (p = 0.002)。在单变量和多变量分析中，PSA 降低 ≥50% 和转移灶体积均与影像学疾病进展风险降低显着相关（HR 0.41，95% CI 0.21-0.80，p = 0.0113）以及癌症转移风险降低显着相关。癌症特异性死亡率（HR 0.29，95% CI 0.09-0.87，p = 0.0325）。开始第二次 HT 后 3 个月内 PSA 降低 ≥50% 与影像学疾病无进展生存率和 3 年癌症特异性显着改善相关死亡。这建议在监测第二次 HT 患者中使用 PSA 50% 下降指标，并确定需要通过影像学进一步评估的患者。© 2023。作者，获得 Springer Nature Limited 的独家许可。

The objective of this study was to evaluate the prognostic value of early PSA decline following initiation of second-generation hormone therapy (2nd HT), namely abiraterone acetate or enzalutamide, in patients with taxane-refractory metastatic castrate-resistant prostate cancer (mCRPC) and evaluate utility of this metric in informing intensified surveillance/imaging protocols.We retrospectively identified 75 mCRPC patients treated with 2nd HT following docetaxel failure (defined as PSA rise and radiographic progression). Patients were categorized patients into two cohorts based on the first PSA within 3 months after initiation of therapy: PSA reduction ≥50% (Group A) and PSA reduction <50% (Group B). The primary endpoint was cancer-specific mortality (CSM). The secondary endpoint was radiographic disease progression (rDP) on 2nd HT. In univariate and multivariate analyses, we investigated factors associated with rPD and CSM.We included 75 patients (52 in Group A, 23 in Group B) in the analytic cohort. Baseline clinico-demographic characteristics, including median age, primary Gleason score risk group, median pre-treatment PSA, disease burden, site of metastases, and pre-treatment ECOG score were not statistically different between the two groups. Median follow up time was 30 months and the median time to radiographic disease progression was 28.1 and 12.5 months (p = 0.002) in cohorts A and B, respectively. On univariate and multivariate analyses, both PSA reduction ≥50% and volume of metastatic disease were significantly associated with a decreased risk of radiographic disease progression (HR 0.41, 95% CI 0.21-0.80, p = 0.0113) as well as a decreased risk of cancer-specific mortality (HR 0.29, 95% CI 0.09-0.87, p = 0.0325).PSA reduction ≥50% within 3 months of starting 2nd HT was associated with significantly improved radiographic disease progression-free survival and 3-year cancer-specific mortality. This suggests using PSA 50%-decline metric in surveillance patients with on 2nd HT and identifies patients who require further evaluation with imaging.© 2023. The Author(s), under exclusive licence to Springer Nature Limited.