Apalutamide‑induced prostate‑specific antigen response and its association with clinical outcomes in metastatic castration sensitive prostate cancer (Review)

N,Srivatsa; Mv,Chandrakanth; Upadhyay,Avinash; Sonone,Pankaj; Dharmadhikari,Shruti; Puppalwar,Gaurav; Khandhedia,Chintan; Mane,Amey; Mehta,Suyog

doi:10.3892/mco.2026.2964

September-2026 Volume 25 Issue 3

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September-2026 Volume 25 Issue 3

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Review Open Access

Apalutamide‑induced prostate‑specific antigen response and its association with clinical outcomes in metastatic castration sensitive prostate cancer (Review)

Authors:
- Srivatsa N
- Chandrakanth Mv
- Avinash Upadhyay
- Pankaj Sonone
- Shruti Dharmadhikari
- Gaurav Puppalwar
- Chintan Khandhedia
- Amey Mane
- Suyog Mehta
View Affiliations / Copyright

Affiliations: Department of Uro‑Oncology, Sri Shankara Cancer Hospital and Research Centre, Sri Shankara Cancer Foundation, Affiliated to Rajiv Gandhi University of Health Sciences, Bengaluru, Karnataka 560070, India, Department of Medical Oncology and Hemato‑Oncology, Narayana Super Speciality Hospital and Cancer Institute, Affiliated to West Bengal University of Health Sciences, Howrah, West Bengal 711103, India, Consultant, Department of Medical Oncology, BIG Apollo Spectra Hospitals, Patna, Bihar 800007, India, Sun Pharma Laboratories Limited, Mumbai, Maharashtra 400063, India

Copyright: © N et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
Article Number: 55
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Published online on: July 20, 2026

https://doi.org/10.3892/mco.2026.2964
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Abstract

Prostate‑specific antigen (PSA) kinetics in metastatic castration‑sensitive prostate cancer (mCSPC) have been evaluated as prognostic markers in relation to clinical outcomes under apalutamide plus androgen deprivation therapy (ADT). A literature search was conducted via PubMed, Scopus and Google Scholar. Randomized controlled trials, post hoc analyses, and real‑world and retrospective cohort studies were included. Early and deep PSA responses (for example, PSA50, PSA90, PSA ≤0.2 ng/ml, ultralow PSA) were found to be induced more frequently and more rapidly when apalutamide + ADT were used. Such PSA responses at 3‑6 months were correlated with prolonged radiographic progression‑free survival, overall survival, and delayed progression to castration‑resistant prostate cancer (CRPC). Comparative analyses demonstrated that PSA90 or ultralow PSA thresholds were reached sooner and in more patients with apalutamide than with abiraterone or enzalutamide, resulting in lower mortality at 24 months in real‑world data. It is concluded that rapid, deep PSA suppression under apalutamide + ADT is associated with improved clinical outcomes in mCSPC. PSA response metrics are proposed to be considered as early surrogate endpoints for guiding treatment decisions but are recommended to be used in conjunction with imaging and clinical assessment.

Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Apalutamide‑induced prostate‑specific antigen response and its association with clinical outcomes in metastatic castration sensitive prostate cancer (Review)

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Abstract

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