How Does Performance Status Affect the Efficacy of Systemic Therapy for Prostate Cancer?

By Emily Menendez - Last Updated: October 12, 2023

Little data exist on the effects of performance status (PS) on the oncological outcomes of patients with prostate cancer (PCa). To determine the efficacy of systemic therapies in patients with worse PS who are treated for high-risk nonmetastatic prostate cancer, metastatic hormone-sensitive prostate cancer (mHSPC), and  metastatic/nonmetastatic castration-resistant prostate cancer (nmCRPC), a team of researchers performed a meta-analysis to study several randomized, controlled trials (RCTs) to determine a correlation.

Three different databases were searched for RCTs involving patients with PCa who were treated with systemic therapy, such as adding an androgen-receptor signaling inhibitor (ARSI) or docetaxel to androgen deprivation therapy (ADT). The oncological outcomes of patients with worse PS were compared with those with good PS for overall survival (OS), metastasis-free survival (MFS), and progression-free survival.

A total of 25 RCTs were included for systematic review, along with 18 for meta-analyses/network meta-analyses. Combination systemic therapies were found to significantly improve OS in patients with worse and good PS in all clinical settings. In patients with nmCRPC, the MFS benefit from an ARSI was more pronounced in those with good PS over worse PS (P=.002).

In an analysis of treatment ranking in patients with mHSPC, triplet therapy had the highest likelihood of improving OS irrespective of PS. Adding darolutamide to docetaxel plus ADT gave patients with worse PS the highest likelihood of improved OS.

The study was limited by the small proportion of patients with a PS ≥1 (19%-28%), and the number of patients with a PS of 2 was rarely reported. Novel systemic therapies can benefit the OS of patients with PCa irrespective of PS. A worse PS should not discourage treatment intensification across disease stages.