Next-generation androgen pathway inhibitors decrease PSA levels and delay progression to castration resistance in real-world patients with metastatic hormone-sensitive prostate cancer (mHSPC), according to data presented at the American Urological Association’s 2023 Annual Meeting in Chicago, Illinois.

From September 2018 to April 2022, a total of 589, 597, and 553 patients with mHSPC initiated apalutamide, enzalutamide, and abiraterone acetate, respectively, at 77 community-based urology practices in the United States. Mean baseline PSA was 19.2, 18.8, and 24.3 ng/mL, respectively. Mean age was 76 years in each group.

At 12 months, a 90% decline in PSA occurred in 72.3%, 61.6%, and 54.7% of patients taking apalutamide, enzalutamide, and abiraterone acetate, respectively, Benjamin Hugh Lowentritt, MD, of Chesapeake Urology Associates in Towson, Maryland, and colleagues reported. Among men with a baseline PSA greater than 0.2 ng/mL, 80.6%, 63.2%, and 58.4% in each group, respectively, attained a PSA of 0.2 ng/mL by 12 months.

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Within 24 months, progression to castration resistance occurred in 33.5%, 38.6%, and 44.5% of patients taking apalutamide, enzalutamide, and abiraterone acetate, respectively, the investigators reported.

“This is among the first observational studies to describe real-world PSA response and progression to [castration-resistance] in mCSPC patients treated with [androgen inhibitors] in US community urology practices,” Dr Lowentritt’s team noted. “In patients with mHSPC, PSA response is associated with increased overall survival and decreased castration resistance, an important indicator of disease progression.” They cautioned, that it’s premature to conclude that PSA response due to specific androgen inhibitors led to lower rates of progression to castration resistance. .

Disclosure: This research was supported by Janssen Scientific Affairs, LLC. Please see the original reference for a full list of disclosures.


Lowentritt B, Du S, Rossi C, et al. Prostate-specific antigen response and time-to-castration resistance among patients with metastatic castration sensitive prostate cancer initiated on apalutamide, enzalutamide, or abiraterone acetate. Presented at: AUA 2023, Chicago, Illinois, April 28-May 1. Presentation MP29-14.