Radiographic progression without PSA progression in advanced prostate cancer patients.
Bibliographic record
Abstract
213 Background: Androgen Receptor Pathway Inhibitors (ARPIs) are frequently combined with Androgen Deprivation Therapy (ADT) to treat prostate cancer patients (pts) with castration sensitive (CSPC) or castration resistant (CRPC) disease. We sought to characterize pts who experienced radiographic progression without PSA progression (R-PD) while under treatment with ADT with or without an ARPI. Methods: We undertook a retrospective analysis of two phase 3 trials testing apalutamide (Apa) + ADT vs Placebo (Pbo) + ADT: TITAN (NCT02489318) in pts with metastatic CSPC (mCSPC) and SPARTAN (NCT01946204) in pts with non-metastatic CRPC (nmCRPC). We compared pts with R-PD with pts who experienced PSA progression before or concurrently with radiographic progression (PSA-PD). Kaplan-Meier and Cox proportional-hazard models were used to estimate time-to-event and hazard ratios. Results: The distribution of types of progression, and location of R-PD by study is shown in the table. Pts with R-PD had shorter overall survival (OS) compared with PSA-PD pts in both studies (median OS R-PD vs PSA-PD: 22.9 m vs 37.4 m in TITAN; 49.8 m vs 53.7 m in SPARTAN). Compared with Pbo, Apa delayed the time to R-PD in both studies (HR 0.51, 95% CI: 0.36 to 0.73 in TITAN; HR 0.17, 95% CI: 0.1 to 0.28 in SPARTAN). No pre-treatment variables predictive of R-PD vs PSA-PD were identified; transcriptional profile analysis is ongoing. Conclusions: Radiographic progression in the absence of PSA progression is not uncommon amongst patients with advanced prostate cancer, and carries a poor prognosis. The addition of Apa prolongs the median time to R-PD. Our findings underscore the importance of monitoring these pts with imaging, independent of PSA dynamics. The impaired survival of R-PD pts warrants evaluation of new therapeutic approaches for these pts. OVERALL TITAN (mCSPC; n=1052) SPARTAN (nmCRPC; n=1207) % pts with R-PD 12.4% 10.4% % pts with PSA-PD 41.2% 45.4% Sites of progression in R-PD pts (% of randomized pts) Bone only 6.3% 1% Non-bone 6% 8.8% Both 0.1% 0%
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".