Disease progression patterns and association of prostate-specific antigen level with risk of progression in nonmetastatic castration-resistant prostate cancer.
Alicia K Morgans, Christopher J D Wallis, Susan Halabi et al.
✦ AI-curated · Sources linked
In 30 seconds
This post hoc analysis of the randomized ARAMIS trial examined disease progression and its association with PSA response in patients with nonmetastatic castration-resistant prostate cancer receiving darolutamide plus androgen-deprivation therapy (ADT) or placebo plus ADT. Metastatic progression occurred in 14% of darolutamide-treated patients and 29% of placebo-treated patients. Among patients receiving darolutamide, reaching PSA < 0.2 ng/ml was associated with less radiological progression than not reaching that level. Metastases sometimes occurred without PSA progression, supporting assessment of both PSA and imaging.
Key findings
- Metastatic progression occurred in 14% with darolutamide versus 29% with placebo.
- At 12 months, PSA progression alone occurred in 7.8% versus 35.9%, and combined PSA and radiological progression in 5.4% versus 21.4%, respectively.
- Among darolutamide recipients, radiological progression at 24 months was 8.7% with PSA < 0.2 ng/ml versus 33% without that response.
- Radiological progression without PSA progression accounted for 35% of metastatic events with darolutamide and 23% with placebo.
Why it matters
PSA response can help characterize progression risk, but it does not capture every metastatic event. In this trial analysis, some metastases occurred without PSA progression, and deep PSA response was associated with less radiological progression. These findings underscore the complementary information provided by PSA measurements and imaging when monitoring disease progression in nmCRPC.
What to keep in mind
The progression analyses were post hoc; the reported association between deep PSA response and radiological progression does not establish that the PSA response caused the lower progression rate.