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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.
View Figures

Figure 1

Mechanism of action of
apalutamide.

Figure 2

Comparative summary of PSA90 response
and median time to PSA90 with apalutamide, enzalutamide and
abiraterone in real-world studies. PSA, prostate-specific antigen;
AR, androgen receptor; DHT, dihydrotestosterone.
View References

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Spandidos Publications style
N S, Mv C, Upadhyay A, Sonone P, Dharmadhikari S, Puppalwar G, Khandhedia C, Mane A and Mehta S: Apalutamide‑induced prostate‑specific antigen response and its association with clinical outcomes in metastatic castration sensitive prostate cancer (Review). Mol Clin Oncol 25: 55, 2026.
APA
N, S., Mv, C., Upadhyay, A., Sonone, P., Dharmadhikari, S., Puppalwar, G. ... Mehta, S. (2026). Apalutamide‑induced prostate‑specific antigen response and its association with clinical outcomes in metastatic castration sensitive prostate cancer (Review). Molecular and Clinical Oncology, 25, 55. https://doi.org/10.3892/mco.2026.2964
MLA
N, S., Mv, C., Upadhyay, A., Sonone, P., Dharmadhikari, S., Puppalwar, G., Khandhedia, C., Mane, A., Mehta, S."Apalutamide‑induced prostate‑specific antigen response and its association with clinical outcomes in metastatic castration sensitive prostate cancer (Review)". Molecular and Clinical Oncology 25.3 (2026): 55.
Chicago
N, S., Mv, C., Upadhyay, A., Sonone, P., Dharmadhikari, S., Puppalwar, G., Khandhedia, C., Mane, A., Mehta, S."Apalutamide‑induced prostate‑specific antigen response and its association with clinical outcomes in metastatic castration sensitive prostate cancer (Review)". Molecular and Clinical Oncology 25, no. 3 (2026): 55. https://doi.org/10.3892/mco.2026.2964
Copy and paste a formatted citation
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Spandidos Publications style
N S, Mv C, Upadhyay A, Sonone P, Dharmadhikari S, Puppalwar G, Khandhedia C, Mane A and Mehta S: Apalutamide‑induced prostate‑specific antigen response and its association with clinical outcomes in metastatic castration sensitive prostate cancer (Review). Mol Clin Oncol 25: 55, 2026.
APA
N, S., Mv, C., Upadhyay, A., Sonone, P., Dharmadhikari, S., Puppalwar, G. ... Mehta, S. (2026). Apalutamide‑induced prostate‑specific antigen response and its association with clinical outcomes in metastatic castration sensitive prostate cancer (Review). Molecular and Clinical Oncology, 25, 55. https://doi.org/10.3892/mco.2026.2964
MLA
N, S., Mv, C., Upadhyay, A., Sonone, P., Dharmadhikari, S., Puppalwar, G., Khandhedia, C., Mane, A., Mehta, S."Apalutamide‑induced prostate‑specific antigen response and its association with clinical outcomes in metastatic castration sensitive prostate cancer (Review)". Molecular and Clinical Oncology 25.3 (2026): 55.
Chicago
N, S., Mv, C., Upadhyay, A., Sonone, P., Dharmadhikari, S., Puppalwar, G., Khandhedia, C., Mane, A., Mehta, S."Apalutamide‑induced prostate‑specific antigen response and its association with clinical outcomes in metastatic castration sensitive prostate cancer (Review)". Molecular and Clinical Oncology 25, no. 3 (2026): 55. https://doi.org/10.3892/mco.2026.2964
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