What question did this study set out to answer?

This research aims to determine the impact of PSA nadir on outcomes from ARPI doublet and docetaxel triplet therapies in metastatic prostate cancer.

May 30, 2026

PSA nadir–stratified outcomes of ARPI doublet and docetaxel triplet therapy in metastatic prostate cancer.

Key Points

This research aims to determine the impact of PSA nadir on outcomes from ARPI doublet and docetaxel triplet therapies in metastatic prostate cancer.
Analyzed data from the Patient360 Prostate dataset, linked to health records and mortality data.
Included patients receiving ARPI doublet, docetaxel doublet, or triplet regimens.
Estimated overall survival using Kaplan–Meier methods.
42.9% of ARPI doublet patients achieved PSA nadir < 0.2 ng/mL versus 29.1% for docetaxel doublet and 30.2% for triplet.
Median overall survival was 109 months for ARPI doublet, 79 months for triplet, and 64 months for docetaxel doublet.
In patients achieving PSA nadir < 0.2 ng/mL, OS was 202, 128, and 104 months respectively, highlighting the importance of PSA nadir.

Abstract

e17096 Background: Therapy intensification has expanded combination strategies in metastatic prostate cancer (mPC) with improved outcomes in clinical trials. However, it remains unclear which patients derive incremental benefit from the addition of upfront docetaxel to androgen receptor pathway inhibitor (ARPI)–based doublet therapy. Methods: We identified adults with prostate cancer in the Patient360 Prostate dataset, a U.S.-based de-identified data source derived from electronic health records, linked claims, and mortality data. Patients initiating ARPI doublet (ARPI + androgen deprivation therapy ADT), docetaxel doublet (docetaxel + ADT), or triplet (ARPI + ADT + docetaxel) were included. Patient characteristics and treatment regimens were summarized descriptively; overall survival (OS) was estimated using Kaplan–Meier methods. Results: Patients with mPC were diagnosed between 1990 and 2025. Among patients without privacy-compliant date of birth suppression, median age was 67 years; 79.4% were White and 14.3% Black. ECOG performance status was 0–1 in 86.4%. ARPI doublet was the most common regimen (n = 7,676), followed by triplet (n = 1,389) and docetaxel doublet (n = 1,282; total n = 10,347). Compared with ARPI doublet, patients who received docetaxel-containing regimens had higher prevalence of adverse baseline features, including de novo metastatic disease (triplet 65.7%; docetaxel doublet 68.4% vs ARPI doublet 55.2%), liver metastases (14.8% and 17.9% vs 8.7%), and high-grade disease (Gleason 8–10: 55.5% and 57.2% vs 49.2%). Bone-supportive therapy use was also higher (66.7% and 73.4% vs 56.9%, respectively). A PSA nadir 200 ng/mL (HR 1.39), and Gleason score 8–10 (all p < 0.0001). Conclusions: In the largest cohort to date comparing ARPI doublet and triplet therapy, ARPI doublet was the most common regimen and was associated with more favorable outcomes, even after multivariable adjustment. Non-achievement of PSA nadir identifies a population with poorer survival in whom docetaxel triplet therapy may be associated with improved outcomes, supporting the rationale underlying the TRIPLE-SWITCH (SWOG/CCTG-PR26) clinical trial.

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