Metastatic CSPC: Educating Patients on PSA Levels


Shared insight on optimal patient monitoring strategies while administering therapy for metastatic castration-sensitive prostate cancer.


Neeraj Agarwal, MD: I’ll ask the last question to Ben about the discussion you have with the patients regarding the PSA [prostate-specific antigen] response. I saw your data presented at ASCO [American Society of Clinical Oncology Annual Meeting]. How important is the PSA to your patients? How does it affect quality of life?

Benjamin Lowentritt, MD: There are a couple of different questions. PSA is certainly an incredibly important thing to the patients as far as their quality of life; it makes them feel better about their response, and it gives them something tangible to measure. However, there’s increasing evidence about PSA as a predictive marker for length of response and that patients with profound drops in their PSA have a more prolonged response. From my standpoint it still has a value. Also, there’s the risk stratification if a patient doesn’t get a 90% drop in their PSA. We know they’re more likely to progress more quickly. Based on the prior discussion we just had, this might mean those are the patients you’re going to image a little more regularly, or those are the patients that you’re going to continue to bring into the office a little more regularly. I personally make sure that I see patients at least 2 months in the initial period, but if they have a significant response, we’ll spread that out to every 3 months. Once again, the scanning may be impacted by that. The real-world evidence is increasingly showing that the PSA response is a predictor of a long-term response, and we have evidence from the TITAN trial as well that suggest that as post hoc analysis. That continues to be an important part of the overall discussion and continuing risk stratification of our patients.

Neeraj Agarwal, MD: Thank you. I’d like to add that especially with prognostication and counseling, we saw the data presented by Dr Kim Chi. Simon [Chowdhury], you were there. For many other authors, including Dr Eric Small, experiencing PSA level of 0.2 ng/mL or less in the hormone-sensitive prostate cancer setting vs not was associated with a hazard ratio of 0.17 favoring a PSA level of 0.2 ng/mL or less. There was an 80% reduction in risk of death as indicated by the PSA response. I agree that it remains a very important point. If that happens for our patients, then that allows me to de-escalate the follow-up, de-escalate the frequency of scans and many other follow-ups associated with these visits.

Transcript edited for clarity.

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