OBJECTIVES To investigate the recent real-world use of first-generation antiandrogens (FGAs) in metastatic castration-resistant prostate cancer (mCRPC) using a retrospective multicentre cohort study. PATIENTS AND METHODS The electronic CRPC Australian Database (ePAD) was interrogated to identify patients with mCRPC. Clinicopathological features, treatment and outcome data, stratified by FGA use, were retrieved and reported through descriptive statistics. Survival analyses were calculated using the Kaplan-Meier method and groups compared using log-rank tests. Factors influencing overall survival (OS) were analysed using Cox proportional hazards regression model. RESULTS We identified 634 patients with mCRPC, enrolled in ePAD between January 2016 and March 2019, including 322 (51%) who received FGAs. The median follow-up was 21.9 months. Patients treated with FGAs were more likely to have lower International Society of Urological Pathologists (ISUP) grade group (P = 0.04), longer median time to CRPC (25.6 vs 16.0 months, P < 0.001), and were less likely to have visceral metastases (5.0% vs 11.2%, P = 0.005) or to have received upfront docetaxel (P < 0.001). A ≥50% reduction from pre-treatment prostate-specific antigen (PSA) level (PSA50 response) during FGA treatment occurred in 119 (37%) patients and was independently associated with improved OS (hazard ratio 0.233, P < 0.001). Prior FGA treatment did not significantly influence the selection of subsequent life-prolonging treatments for mCRPC or their PSA50 response rates. CONCLUSION In our present cohort, FGAs were commonly used in lower-risk mCRPC and their use did not significantly influence the choice or duration of subsequent systemic therapy. A PSA50 response to FGA therapy was an independent favourable prognostic marker associated with improved OS.

中文翻译：

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第一代抗雄激素的真实使用：对转移性去势抵抗性前列腺癌患者预后和后续治疗的影响。

目的 使用回顾性多中心队列研究调查第一代抗雄激素 (FGA) 在转移性去势抵抗性前列腺癌 (mCRPC) 中最近的真实使用情况。患者和方法 询问电子 CRPC 澳大利亚数据库 (ePAD) 以识别 mCRPC 患者。通过描述性统计检索和报告按 FGA 使用分层的临床病理学特征、治疗和结果数据。生存分析使用 Kaplan-Meier 方法计算，组间比较使用对数秩检验。使用 Cox 比例风险回归模型分析影响总生存 (OS) 的因素。结果 我们确定了 2016 年 1 月至 2019 年 3 月期间参加 ePAD 的 634 名 mCRPC 患者，其中 322 名（51%）接受了 FGA。中位随访时间为 21.9 个月。接受 FGA 治疗的患者更有可能具有较低的国际泌尿病理学家协会 (ISUP) 等级组 (P = 0.04)、更长的 CRPC 中位时间（25.6 个月 vs 16.0 个月，P < 0.001），并且不太可能发生内脏转移（5.0% 对 11.2%，P = 0.005）或预先接受多西他赛（P < 0.001）。119 名 (37%) 患者在 FGA 治疗期间与治疗前前列腺特异性抗原 (PSA) 水平（PSA50 反应）相比降低了 ≥50%，并且与 OS 改善独立相关（风险比 0.233，P < 0.001）。先前的 FGA 治疗不会显着影响后续延长生命的 mCRPC 治疗的选择或其 PSA50 反应率。结论 在我们目前的队列中，FGAs 通常用于低风险 mCRPC，它们的使用不会显着影响后续全身治疗的选择或持续时间。对 FGA 治疗的 PSA50 反应是与改善的 OS 相关的独立的有利预后标志物。