How low do you need to go? Association between various prostate-specific antigen response measures and clinical outcomes in metastatic castration-sensitive prostate cancer in the Veterans Health Administration data
Cancer, August 2026
Among patients with metastatic castration-sensitive prostate cancer (mCSPC), undetectable levels (less than 0.2 ng/mL) of absolute prostate-specific antigen (PSA) within nine months of initiating treatment have been associated with improved survival outcomes, as compared to a percentage of PSA decline. Despite this, 85 percent of physicians surveyed used a percentage of PSA decline as the key metric of patient response to treatment, indicating an educational gap between reliance on recommended metrics and real-world practices. Further information about the connection between absolute PSA levels and clinical outcomes may help health care providers understand whether patients with mCSPC could be candidates for more or less intensive treatment regimens.
To provide a perspective on optimal PSA metrics for bedside decisions, Analysis Group Managing Principal Hongbo Yang, Vice President Wei Gao, and Senior Analysts Jingyi Chen and Grace Chen collaborated with investigators from Cedars-Sinai Medical Center, Astellas Pharma, and Pfizer on a retrospective analysis of Veterans Health Administration (VHA) patient data. In an article on their findings, the researchers observed improved clinical outcomes among patients with mCSPC who had undetectable absolute PSA levels, regardless of the percentage of their PSA decline. They also found that patients initiating intensified treatments were more likely to achieve those low absolute PSA levels. The authors conclude that an absolute PSA low point of less than 0.2 ng/mL – as opposed to a percentage of PSA decline – is the optimal measure for identifying patients with mCSPC who are likely to have improved survival outcomes and delayed disease progression.
The study, “How low do you need to go? Association between various prostate-specific antigen response measures and clinical outcomes in metastatic castration-sensitive prostate cancer in the Veterans Health Administration data,” was featured in the American Society of Clinical Oncology’s (ASCO’s) Cancer in the News (paywall) and published in Cancer, the Interdisciplinary International Journal of the American Cancer Society.
Authors
Freedland SJ, Gao W, Touya M, Yang H, Russell D, Chen J, Chen G, Ivanova JI