ArticleWorld journal of urology2026
Association of time to upfront treatment initiation with outcomes in metastatic hormone-sensitive prostate cancer: a 4-month landmark analysis.
Article in World journal of urology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe clinical significance of variation in the timing of treatment intensification after androgen deprivation therapy (ADT) initiation in metastatic hormone-sensitive prostate cancer (mHSPC) remains unclear. We evaluated whether time to upfront treatment initiation was associated with outcomes in a multicenter cohort.
methodsIn a retrospective study, we performed a 4-month landmark analysis in patients with mHSPC treated with upfront androgen receptor signaling inhibitor-based or taxane-containing regimens who had evaluable CRPC data and complete baseline covariates. The cohort included 1,103 patients, classified as earlier initiation (< 4 months from ADT start; n=1,036) or later initiation (≥ 4 months; n=67). CRPC-free survival (CRPC-FS) and overall survival (OS) were evaluated using Kaplan-Meier and inverse probability of treatment weighting (IPTW)-adjusted Cox analyses. Restricted cubic spline analyses examined the continuous association between treatment delay and outcomes. Sensitivity analysis used a 3-month landmark.
resultsIn the 4-month landmark IPTW cohort, later initiation was not significantly associated with either CRPC-FS (hazard ratio [HR] 1.05, 95% confidence interval [CI] 0.80-1.37; p=0.737) or OS (HR 0.77, 95% CI 0.45-1.32; p=0.338). Delay distributions differed by regimen, with docetaxel-containing regimens showing longer intervals to upfront treatment. Adjusted spline analyses did not suggest a clear threshold at which longer delay was associated with marked deterioration in CRPC-FS or OS. Results were consistent in the 3-month landmark sensitivity analysis.
conclusionsAmong patients who remained alive and CRPC-free at the 4-month landmark and ultimately received treatment intensification, later initiation was not significantly associated with CRPC-FS or OS.
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