Survival outcomes of real world patients with metastatic hormone-sensitive prostate cancer who do not achieve optimal PSA response with intensified androgen deprivation therapy with docetaxel or androgen receptor pathway inhibitors

Introduction In patients with metastatic hormone-sensitive prostate cancer (mHSPC) undergoing intensified androgen deprivation therapy (ADT), not achieving an optimal PSA response, defined as PSA nadir >0.2 ng/ml (PSA subOR ) has been associated with worse survival outcomes in clinical trials (1)(10)(11) . Here, we externally evaluate, the impact of optimal PSA response on survival outcomes in these patients and provide absolute PFS and OS measures in those with PSA subOR in the context of ADT intensification in real world setting. Methods In this retrospective study, all consecutive patients with mHSPC who underwent intensified ADT treated at our institution, and whose outcomes data were available, were included. We classified patients based on their PSA nadir on treatment: those with a on treatment PSA OR (PSA nadir ≤0.2 ng/ml) versus PSA subOR . Results A total of 205 patients were eligible: 136 (66.3%) patients achieved PSA OR versus 69 (33.7%) patients had PSA subOR . Patients who experienced a PSA OR had significantly improved PFS and OS from the start of intensified ADT versus who did not: PFS was not reached (NR) versus 11 months (hazard ratio (HR) 0.20, P