Background/Objectives: Progression to metastatic castration-resistant prostate cancer (mCRPC) is defined either biochemically, radiographically or both. Moreover, staging for mCRPC can be performed either conventionally or with molecular imaging such as prostate-specific membrane antigen computer tomography (PSMA-PET/CT).Methods: We relied on the Frankfurt Metastatic Cancer Database of the Prostate (FRAMCAP) database to compare progression-free (PFS) and overall survival (OS) outcomes regarding the cause of castration resistance and the staging modality used.Results: Overall, 35% progressed to mCRPC biochemically vs. 23% radiographically vs. 42% biochemically + radiographically. The PSA nadir in mHSPC (1.4 vs. 0.4 vs. 0.8 ng/mL) and PSA level at mCRPC progression (15 vs. 2 vs. 21 ng/mL, bothp≤ 0.01) were significantly higher for biochemical vs. radiographic vs. both progressed patients. In PFS and OS analyses, no significant differences were observed among all three compared groups. In the comparison of the staging used for progression to mCRPC, 67% received conventional vs. 33% PSMA-PET/CT, with higher metastatic burden in mHSPC and osseous lesions in mCRPC for conventionally staged patients (bothp< 0.01). In PFS (15.3 vs. 10.1 months, hazard ratio [HR]: 0.75) and OS analyses (52.6 vs. 34.3 months, HR: 0.61, bothp< 0.05), PSMA-PET/CT harbored better prognosis; however, this did not hold after multivariable adjustment. Similar results were observed for further analyses in second- and third-line mCRPC or patients with a PSA level of ≥2 ng/mL.Conclusions: The cause of progression to mCRPC seems not to influence cancer-control outcomes, despite important baseline tumor characteristic differences. The PSMA-PET/CT staging modality might be associated with better PFS and OS outcomes, possibly due to its more sensitive detection of progression or new metastatic lesions.
背景/目的：转移性去势抵抗性前列腺癌（mCRPC）的进展可通过生化指标、影像学检查或两者结合进行定义。此外，mCRPC的分期可采用传统方法或分子影像学（如前列腺特异性膜抗原计算机断层扫描[PSMA-PET/CT]）进行。方法：本研究基于法兰克福前列腺转移癌数据库（FRAMCAP），比较不同去势抵抗原因及分期方式对无进展生存期（PFS）和总生存期（OS）的影响。结果：总体而言，35%的患者仅通过生化指标进展为mCRPC，23%仅通过影像学进展，42%通过两者结合进展。在生化进展组、影像学进展组及两者结合进展组中，转移性激素敏感性前列腺癌（mHSPC）阶段的前列腺特异性抗原最低值（分别为1.4 vs. 0.4 vs. 0.8 ng/mL）及mCRPC进展时的PSA水平（分别为15 vs. 2 vs. 21 ng/mL，均p≤0.01）存在显著差异。在PFS和OS分析中，三组间未观察到显著差异。在mCRPC进展分期方式的比较中，67%采用传统分期，33%采用PSMA-PET/CT分期。传统分期患者在mHSPC阶段转移负荷更高，mCRPC阶段骨转移病灶更多（均p<0.01）。PSMA-PET/CT分期在PFS（15.3 vs. 10.1个月，风险比[HR]：0.75）和OS（52.6 vs. 34.3个月，HR：0.61，均p<0.05）方面预后更佳，但经多变量调整后该差异不再显著。在二线/三线mCRPC治疗或PSA水平≥2 ng/mL患者的进一步分析中也观察到类似结果。结论：尽管不同进展方式的基线肿瘤特征存在显著差异，但进展至mCRPC的原因似乎不影响癌症控制结局。PSMA-PET/CT分期方式可能与更好的PFS和OS结果相关，可能源于其对疾病进展或新转移病灶更敏感的检测能力。
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