PSA below 0.2 ng/mL predicts prostate cancer survival

A real-world study published online in CANCER, a peer-reviewed journal of the American Cancer Society, analyzed data from 4,890 patients with metastatic hormone-sensitive prostate cancer treated through the United States — Veterans Health Administration between 2018 and 2023. The study found that patients whose prostate-specific antigen (PSA) levels dropped below 0.2 ng/mL within nine months of starting androgen-deprivation therapy were 54% less likely to die during a median follow-up of about two years, compared to those who did not reach this threshold. This association held regardless of whether patients also achieved a 90% PSA decline. Patients who achieved a 90% decline but did not reach the absolute threshold showed no significant survival benefit. The findings suggest that the absolute PSA level is a more informative prognostic marker than percentage decline alone. Patients receiving combination therapy (testosterone deprivation plus an additional androgen-blocking drug) were more likely to reach the target. The study's corresponding author, Stephen J. Freedland, emphasized that targeting a PSA below 0.2 ng/mL should be the metric of success in treating metastatic prostate cancer. The research was published by Wiley and supported by the American Cancer Society.