PURPOSE Among various therapeutic options available for metastatic castration-resistant prostate cancer (mCRPC), only apalutamide and enzalutamide have shown evidences of improved metastasis-free survival (MFS) for non-metastatic castration-resistant prostate cancer (nmCRPC). However, there is a paucity of evidence to indicate who may be targeted for aggressive therapy among patients with nmCRPC. The objectives of this retrospective study were to explore predictors of metastasis in patients with nmCRPC and to identify a subpopulation of patients with nmCRPC who may benefit from aggressive therapy. METHODS A total of 115 patients with CRPC who had no metastasis detected at the time of diagnosis of CRPC were included in this retrospective study. All patients were treated at Jikei University and its affiliated hospitals. The primary outcome measure was MFS from the time of diagnosis of CRPC. Predictors of MFS were also explored with a multivariate Cox hazard model. RESULTS The median observation period after diagnosis of CRPC was 30 months (range 2-143 months). Kaplan-Meier analysis revealed a median MFS of 76. Multivariate analysis demonstrated that low alkaline phosphatase (ALP) values at diagnosis of CRPC and favorable response to primary androgen deprivation therapy (ADT) were significant predictors of longer MFS (P = 0.011, and 0.031, respectively). CONCLUSIONS Results of this study suggest that high ALP values at diagnosis of CRPC and poor response to primary ADT may predict the propensity of metastasis in patients with nmCRPC. Further prospective studies will be required enrolling more patients to confirm our findings.

中文翻译：

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碱性磷酸酶在去势抵抗性诊断和对原发雄激素剥夺治疗反应的诊断中的价值，可作为非转移性去势抵抗性前列腺癌后续转移的预测指标。

目的在针对转移性去势抵抗性前列腺癌（mCRPC）的各种治疗选择中，只有阿帕鲁胺和恩杂鲁胺显示出改善非转移性去势抵抗性前列腺癌（nmCRPC）的无转移生存率（MFS）的证据。但是，几乎没有证据表明nmCRPC患者中谁可能成为积极治疗的目标。这项回顾性研究的目的是探讨nmCRPC患者转移的预测因素，并确定可能受益于积极治疗的nmCRPC患者亚群。方法回顾性研究纳入115例CRPC患者，这些患者在诊断为CRPC时未发现转移。所有患者均在集经大学及其附属医院接受治疗。从CRPC诊断开始，主要结果指标为MFS。还使用多元Cox风险模型探索了MFS的预测因素。结果CRPC诊断后的中位观察期为30个月（范围2-143个月）。Kaplan-Meier分析显示MFS中位数为76。多因素分析表明，在诊断CRPC时碱性磷酸酶（ALP）值低以及对原发雄激素剥夺疗法（ADT）的良好反应是更长MFS的重要预测指标（P = 0.011和0.031） ， 分别）。结论这项研究的结果表明，在诊断CRPC时ALP值高和对原发性ADT的不良反应可能预示了nmCRPC患者转移的倾向。需要更多的前瞻性研究来招募更多的患者以证实我们的发现。