AIM OF THE STUDY Our goal was to evaluate the impact of progression type (prostate-specific antigen [PSA] only, radiological or clinical) at initiation of first-, second- and third life-extending therapy (LET) on treatment outcomes in metastatic castration-resistant prostate cancer (mCRPC) patients, by performing a post-hoc analysis using data from the CATS international registry. METHODS The 669 consecutive mCRPC patients of the CATS registry were classified according to their type of progression at initiation of each LET: PSA only (PSA-p), radiological (±PSA) (Radio-p); or clinical (±PSA, ±radiological) progression (Clin-p). Overall survival (OS), the primary endpoint, was calculated from initiation of the first-, second- and third-LET to death for each sequence. RESULTS Median OS was shorter in the Clin-p group compared with the PSA-p group (14-month difference in first line; around 7-month difference in second- and third line). Shorter progression-free survival (PFS) was also observed in Clin-p patients, whatever the treatment is. Clinical progression seemed to be associated with a shorter duration of therapy with androgen receptor-targeted therapy (ART) compared with taxanes. CONCLUSIONS Clinical progression at initiation of a LET is associated with poor outcomes including shorter PFS and OS as well as clinical and biological features of aggressive disease. Stratifying patients in clinical trials according to disease progression type may prevent selection bias and data heterogeneity. In daily practice, first signs of clinical progression may prompt physicians to consider starting a new LET, independently of PSA levels.

中文翻译：

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无论抗转移性去势抵抗性前列腺癌的治疗方法是什么，临床进展都与不良预后相关：CATS国际数据库。

研究目的我们的目标是评估开始进行第一，第二和第三次生命延长治疗（LET）时进展类型（仅前列腺特异性抗原[PSA]，仅在放射学或临床上）对转移治疗结果的影响通过使用CATS国际注册中心的数据进行事后分析，对去势抵抗性前列腺癌（mCRPC）患者进行了分析。方法根据669名连续的CATS登记的mCRPC患者，根据他们在每个LET开始时的进展类型进行分类：仅PSA（PSA-p），放射学（±PSA）（Radio-p）；或临床（±PSA，±放射学）进展（Clin-p）。从每个序列的第一个，第二个和第三个LET的启动到死亡的总生存期（OS），即主要终点，进行了计算。结果与PSA-p组相比，Clin-p组中位OS较短（第一行相差14个月；第二和第三行相差7个月）。无论采用何种治疗方法，在Clin-p患者中也观察到较短的无进展生存期（PFS）。与紫杉烷类药物相比，临床进展似乎与雄激素受体靶向疗法（ART）的治疗时间较短有关。结论LET发作时的临床进展与不良预后相关，包括较短的PFS和OS以及侵袭性疾病的临床和生物学特征。根据疾病进展类型在临床试验中对患者进行分层可以防止选择偏见和数据异质性。在日常实践中，临床进展的初步迹象可能会促使医生考虑开始新的LET，