目的 探究瑞维鲁胺联合雄激素剥夺治疗（ADT）对转移性激素敏感性前列腺癌（mHSPC）的近远期疗效及对血游离前列腺特异性抗原百分率（FPSAR）、胃泌素释放肽前体（proGRP）表达的影响。 方法 自医院电子病历库与随访数据库收集2022年8月至2024年2月医院收治的mHSPC患者102例的临床资料，按治疗方式分为瑞维鲁胺组（n = 44，瑞维鲁胺联合ADT治疗）与比卡鲁胺组（n = 58，比卡鲁胺联合ADT治疗），倾向性评分匹配（PSM）法平衡两组基线资料，按1∶1最近邻匹配法，卡钳值设定为0.2，最终获得41对无基线差异数据，比较两组近远期疗效，治疗前后血清前列腺特异性抗原（PSA）、乳酸脱氢酶（LDH）、FPSAR、proGRP、中性粒细胞/淋巴细胞比值（NLR）、血小板计数/淋巴细胞比率（PLR），不良事件、生存预后；所有患者按预后结局分组，Cox回归分析法分析mHSPC患者预后影响因素。 结果 治疗24周后，瑞维鲁胺组近期疾病控制率高于比卡鲁胺组，差异有统计学意义（P < 0.05）。治疗后，瑞维鲁胺组血清PSA、LDH、NLR、PLR、proGRP均显著低于同组治疗前及比卡鲁胺组治疗后，FPSAR高于同组治疗前与比卡鲁胺组治疗后，差异均有统计学意义（P < 0.05）。两组不良反应均可控，比较差异无统计学意义（P > 0.05）；瑞维鲁胺组中位无进展生存期（PFS）、中位总生存期（OS）均长于比卡鲁胺组（P < 0.01）。Cox多因素回归分析显示，高瘤负荷、多部位转移、基线高proGRP为mHSPC患者生存预后的危险因素（P < 0.05），瑞维鲁胺 + ADT治疗、基线高FPSAR水平为保护因素（P < 0.05）。 结论 瑞维鲁胺联合ADT治疗mHSPC疾病控制率较高，生存预后更优，能显著上调FPSAR，降低血proGRP水平，且不良反应可控；多部位转移、高瘤负荷、基线高proGRP的mHSPC患者有更差的生存预后，瑞维鲁胺、高FPSAR为保护因素，需重点关注合并上述因素mHSPC患者预后的监测。

Objective To explore the short-term and long-term efficacy of rezvilutamide combined with androgen deprivation therapy （ADT） in treating metastatic hormone-sensitive prostate cancer （mHSPC）， as well as its influence on the blood expression of free prostate specific antigen percentage （FPSAR） and progastrin releasing peptide （proGRP）. Methods Clinical data of 102 patients with mHSPC who were admitted to the hospital from August 2022 to February 2024 were retrieved from the hospital's electronic medical record database and follow-up database. These patients were classified into the rezvilutamide group （n = 44， treated with rezvilutamide combined with ADT） and the bicalutamide group （n = 58， treated with bicalutamide combined with ADT） based on the treatment methods. Propensity score matching （PSM） method was employed to balance the baseline data of the two groups. A 1∶1 nearest-neighbor matching approach was utilized， with a caliper value set at 0.2. Eventually， 41 pairs of data without baseline differences were acquired. The short-term and long-term therapeutic effects of the two groups were compared， including the alterations in serum prostate-specific antigen （PSA）， lactate dehydrogenase （LDH）， FPSAR， proGRP， neutrophil-to-lymphocyte ratio （NLR）， and platelet count-to-lymphocyte ratio （PLR） before and after treatment， adverse events， and survival prognosis. All patients were grouped according to their prognosis outcomes， and the Cox regression analysis method was applied to analyze the prognostic factors of mHSPC patients. Results Following 24 weeks of treatment， the short-term disease control rate in the rezvilutamide group was higher than that in the bicalutamide group， and this difference was statistically significant （P < 0.05）. Post-treatment， the serum levels of PSA， LDH， NLR， PLR， and proGRP in the rezvilutamide group were significantly lower than those pre-treatment within the same group and post-treatment in the bicalutamide group， whereas the FPSAR was higher. All these differences were statistically significant （P < 0.05）. Both groups experienced manageable adverse reactions， and there was no statistically significant difference between them （P > 0.05）. The median progression-free survival （PFS） and median overall survival （OS） in the rezvilutamide group were longer than those in the bicalutamide group （P < 0.01）. Cox multivariate regression analysis indicated that high tumor burden， multiple metastatic sites， and high baseline proGRP were risk factors for the survival prognosis of mHSPC patients （P < 0.05）， while rezvilutamide + ADT treatment and high baseline FPSAR levels were protective factors （P < 0.05）. Conclusions The combination of rezvilutamide and ADT demonstrates a higher disease control rate and superior survival prognosis in mHSPC. It significantly upregulates FPSAR， reduces blood proGRP levels， and presents controllable adverse reactions. mHSPC patients with multiple metastases， high tumor burden， and elevated baseline proGRP exhibit a poorer survival prognosis. Rezvilutamide and high FPSAR serve as protective factors. Special attention should be given to the prognosis monitoring of mHSPC patients with the aforementioned factors.