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Prostate Cancer Treatment and Research / Prostate Cancer Diagnosis and Treatment · Journal article
Cancer · August 10, 2026
Well-designed and adequately powered for the question it asks.
This large real-world retrospective analysis of 4890 veterans with mCSPC demonstrates that achieving a PSA nadir <0.2 ng/mL within 9 months of ADT initiation is associated with a 54% reduction in mortality risk (adjusted HR 0.46), independent of whether a 90% PSA decline was achieved. The finding supports PSA nadir rather than percentage decline as the preferred response metric for prognostication in mCSPC.
Retrospective cohort study with landmark analysis. Patients with metastatic castration-sensitive prostate cancer who initiated androgen deprivation therapy with or without additional treatments in the Veterans Health Administration system from 2006 to 2024.. Intervention: Androgen deprivation therapy ± androgen receptor pathway inhibitors or other treatments, assessed by PSA response metrics (PSA <0.2 ng/mL and/or ≥90% PSA decline within 9 months).. Compared with: Patients who did not achieve PSA <0.2 ng/mL or did not achieve ≥90% PSA decline, with stratification by combination of both metrics.. n = 4,890. Veterans Health Administration (United States).
44% of 4890 patients achieved PSA <0.2 ng/mL; 74% achieved ≥90% PSA decline PSA <0.2 ng/mL within 9 months associated with adjusted HR 0.46 (95% CI 0.40–0.54) for death OS benefit with PSA <0.2 ng/mL was similar regardless of ≥90% decline (HR 0.43, 95% CI 0.35–0.52) or <90% decline (HR 0.36, 95% CI 0.23–0.56)
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Clinicians should prioritize achievement of PSA nadir <0.2 ng/mL as the treatment target in mCSPC, as this threshold predicts OS benefit independent of absolute percentage PSA decline. A 90% decline without reaching <0.2 ng/mL does not confer the same prognostic advantage and should not be accepted as adequate response.
Large real-world retrospective cohort with 4890 patients, adjusted Cox regression analysis, and hard clinical endpoint (overall survival), demonstrating that PSA nadir <0.2 ng/mL predicts OS benefit independent of percentage decline.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians should prioritize achievement of PSA nadir <0.2 ng/mL as the treatment target in mCSPC, as this threshold predicts OS benefit independent of absolute percentage PSA decline. A 90% decline without reaching <0.2 ng/mL does not confer the same prognostic advantage and should not be accepted as adequate response.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
BACKGROUND: Multiple phase 3 metastatic castration-sensitive prostate cancer (mCSPC) studies consistently show a prostate-specific antigen (PSA) nadir of <0.2 ng/mL to be the preferred threshold for PSA response. However, in real-world practice, physicians often use other metrics such as percentage of PSA decline. METHODS: This retrospective analysis of Veterans Health Administration data (2006-2024) assessed the association between PSA response and overall survival (OS) in patients with mCSPC who initiated androgen deprivation therapy (ADT) ± other treatments, using landmark analyses with adjusted Cox regressions. PSA response metrics included ≥90% PSA decline and a PSA of <0.2 ng/mL within 9 months of starting therapy. RESULTS: Among 4890 patients, 44% reached a PSA of <0.2 ng/mL and 74% had ≥90% PSA decline. Patients with a PSA of <0.2 ng/mL within 9 months of ADT initiation had a reduced risk of death after this time point (adjusted hazard ratio [HR], 0.46; 95% confidence interval [CI], 0.40-0.54) versus patients who did not. OS improvements with a PSA of <0.2 ng/mL were similar, regardless of ≥90% (adjusted HR, 0.43; 95% CI, 0.35-0.52) or <90% PSA decline (adjusted HR, 0.36; 95% CI, 0.23-0.56). Achieving ≥90% PSA decline without a PSA of <0.2 ng/mL was unrelated to improved OS. Patients who initiated ADT plus androgen receptor pathway inhibitors versus ADT alone were more likely to achieve a PSA of <0.2 ng/mL during PSA follow-up (adjusted HR, 1.71; 95% CI, 1.55-1.88). CONCLUSIONS: In a real-world mCSPC setting, achieving a PSA of <0.2 ng/mL (whether or not a PSA decline of 90% was reached) within 9 months of initiating ADT ± other treatments was associated with improved OS, which supports a PSA nadir of <0.2 ng/mL for optimizing mCSPC outcomes.
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