Investigating High-risk Factors, Precise Diagnosis, and Treatment of Castration-Resistant Prostate Cancer (CRPC)

Yuan Ma; Zihao Liu; Wenyue Yu; Hua Huang; Yong Wang; Yuanjie Niu

doi:10.2174/0113862073266959231114052928

Investigating High-risk Factors, Precise Diagnosis, and Treatment of Castration-Resistant Prostate Cancer (CRPC)

Comb Chem High Throughput Screen. 2023 Nov 21. doi: 10.2174/0113862073266959231114052928. Online ahead of print.

Authors

Yuan Ma^{1

2}, Zihao Liu^{1

2}, Wenyue Yu², Hua Huang¹, Yong Wang^{1

2}, Yuanjie Niu^{1

2}

Affiliations

¹ Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China.
² Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China.

PMID: 37990901
DOI: 10.2174/0113862073266959231114052928

Abstract

Background: The treatment of metastatic castration-resistant prostate cancer (mCRPC) in the actual world currently presents difficulties. In light of this, it is crucial to investigate high-risk factors for the progression of advanced prostate cancer and to identify methods for delaying the onset of CRPC.

Aims: This study aimed to explore the high-risk factors that impact the progression of prostate cancer and emphasize the significance of precise diagnosis and treatment based on etiological classification in the clinical management of castration-resistant prostate cancer.

Methods: A retrospective analysis was conducted on 277 newly diagnosed cases of PCa treated with endocrine therapy. A follow-up was done on prostate-specific antigen (PSA) levels and testosterone. Additionally, a prospective analysis was performed on the clinical data of 60 patients with CRPC. Following the principle of '4W1H', 30 patients were included in the precision treatment group for a second biopsy and related tests, while another 30 patients were included in the conventional treatment group. The therapeutic effect and prognosis of the two groups were observed.

Results: Distant metastasis (HR = 1.879, 95% CI: 1.311 ~ 2.694, P = 0.001), PSA nadir &gt 0.2 ng/mL (HR = 1.843, 95% CI: 1.338 ~ 2.540, P = 0.001), testosterone nadir &gt 20 ng/dL (HR = 1.403, 95% CI: 1.035 ~ 1.904, P = 0.029), and time to testosterone nadir &gt 6 months (HR = 1.919, 95% CI: 1.364 ~ 2.701, P = 0.001) were risk factors for the progression to CRPC. Patients in the CRPC group were treated with precision therapy and conventional therapy based on their molecular subtyping. The precision treatment group showed a significantly prolonged median PSA progression-free survival compared to the conventional treatment group (16.0 months vs. 13.0 months, P=0.025). The median radiographic progression-free survival was also significantly extended in the precision treatment group compared to the conventional treatment group (21.0 months vs. 16.0 months, P=0.042).

Conclusion: Patients with prostate cancer diagnosed with distant metastasis at initial presentation require early intervention. Close monitoring of PSA and serum testosterone changes is necessary during the process of endocrine therapy. After entering the CRPC stage, the etiological classification precision treatment can improve the therapeutic effect and improve the prognosis of patients.

Keywords: Prostate cancer; biopsy principle; castration-resistant prostate cancer.