For decades, androgen deprivation therapy (ADT), which lowers testosterone levels, was the standard treatment for advanced prostate cancer. However, with the understanding of metastatic hormone-sensitive prostate cancer (mHSPC progression, the addition of docetaxel or an androgen receptor pathway inhibitor (ARPI) – such as abiraterone acetate, darolutamide, apalutamide, or enzalutamide – to ADT has become the suggested approach for these patients. Despite these advancements in mHSPC treatment, outcomes for men with advanced prostate cancer (APC) remain suboptimal. Consequently, this study aimed to identify risk factors associated with improved clinical outcomes in mHSPC.

A retrospective, single-center cohort study was performed to evaluate risk factors associated with favorable clinical outcomes. The study population comprised patients with advanced prostate cancer who underwent ADT, either alone or in combination with abiraterone, apalutamide, or enzalutamide, at Kaohsiung Veterans General Hospital

Consistent with the findings of the IRONMAN trial, which highlighted the superior clinical outcomes (undetectable PSA nadir <0.2 ng/mL) of ADT plus ARPI over other regimens like ADT alone or ADT with docetaxel, our data collection has yielded a total of 80 patients with advanced prostate cancer. Within this cohort, 30 patients demonstrated prolonged ARPI use, defined as maintaining an undetectable PSA for 6 months or more after their diagnosis.

Based on preliminary data from Kaohsiung Veterans General Hospital (KVGH), this research aimed to identify optimal treatment sequences and prognostic factors for improved clinical outcomes in metastatic hormone-sensitive prostate cancer (mHSPC). It is anticipated that the findings will contribute to the development of more appropriate and novel clinical management strategies for this patient population.