Abstract:

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.

Key words: androgen deprivation therapy, rezvilutamide, metastatic hormone-sensitive prostate cancer, free prostate-specific antigen, progastrin-releasing peptide