Radiographic Progression Without Prostate-specific Antigen Progression in Metastatic Hormone-sensitive Prostate Cancer: A Retrospective Analysis of the ENZAMET Trial (ANZUP 1304)

作者：Andrisha-Jade Inderjeeth, Andrew J. Martin, Robert R. Zielinski, Stephen Begbie, Leanna Cheung, Simon Chowdhury, Mark Frydenberg, Lisa Horvath, A. M. Joshua, Nicola Jane Lawrence, Gavin Marx, John McCaffrey, Raymond S. McDermott, Margaret McJannett, Scott North, Francis Parnis, Wendy R. Parulekar, David Pook, M. Neil Reaume, Shahneen Sandhu, Alvin Tan, Thean H. Tan, Alastair Thomson, Francisco Vera-Badillo, Scott G. Williams, Hayley Thomas, Sonia Yip, Alison Y. Zhang, Kim N., Martin R. Stockler, Christopher J. Sweeney, I Stephen Davis · 发表于：European Urology Oncology · 年份：2026 · DOI：10.1016/j.euo.2026.01.008 · 被引用次数：3 · 研究领域：Prostate Cancer Treatment and Research、Prostate Cancer Diagnosis and Treatment、Radiopharmaceutical Chemistry and Applications

BACKGROUND AND OBJECTIVE: ENZAMET randomised 1125 participants with metastatic hormone-sensitive prostate cancer to receive enzalutamide or a standard nonsteroidal antiandrogen (NSAA) combined with testosterone suppression with or without docetaxel. Enzalutamide demonstrated superior progression-free and overall survival (OS). Radiographic progression without prior/concurrent prostate-specific antigen progression (discordant progression; DP) portends poor outcomes. Our aim was to determine the frequency of DP in ENZAMET and the impact of enzalutamide on disease-state transitions. METHODS: A multistate Cox proportional-hazards regression model was used to partition participants into four states: (1) event-free; (2) discordant progression (DP); (3) other types of progression (other progression; OP); and (4) death. KEY FINDINGS AND LIMITATIONS: Enzalutamide prolonged OS in the entire cohort of 1125 participants (hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.58-0.84; p < 0.0001). Radiographic progression occurred in 388/1125 (34%) participants, and DP in 114/1125 (10%), with similar proportions in the enzalutamide arm (55/114, 48%) and NSAA arm (59/114, 52%). Participant characteristics in the DP group were similar between the treatment arms. Enzalutamide delayed DP (HR 0.66, 95% CI 0.46-0.96; p = 0.03) and OP (HR 0.37, 95% CI 0.31-0.44; p < 0.001). The 5-yr OS rate was lower in the DP group (24%) than in the OP group (42%). Among participants whose cancer had not progre...