Prognostic Impact of Ductal Component in Metastatic Hormone-Sensitive Prostate Cancer Treated with ARPI-Based Therapy
Vali Aliyev11Division of Medical Oncology, Department of Internal Medicine, Istanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Türkiye
Objectives: Histological heterogeneity in metastatic hormone-sensitive prostate cancer (mHSPC) may influence treatment outcomes beyond conventional clinical risk models. The prognostic significance of ductal component–containing tumors in patients treated with androgen receptor pathway inhibitors (ARPIs) remains insufficiently defined. Methods: This retrospective single-center cohort study included patients with mHSPC treated with androgen deprivation therapy plus an ARPI between January 2016 and June 2025. Tumors were classified as pure acinar or ductal component– containing based on pathology reports. Radiographic progression-free survival (rPFS) was the primary endpoint, and overall survival (OS) was secondary. Survival analyses were performed using Kaplan–Meier and Cox regression models. Results: A total of 104 patients were included, of whom 18 (17.3%) had ductal component-containing tumors. Median follow-up was 30.5 months. Median rPFS was not reached in the pure acinar group and was 26.7 months in the ductal component group. Ductal component was independently associated with shorter rPFS (hazard ratio [HR] 2.29, 95% CI 1.08–4.87; p=0.031) and OS (HR 6.36, 95% CI 2.15–18.78; p=0.001). Patients with ductal component–containing tumors also showed numerically less favorable PSA response patterns, including lower rates of deep PSA decline. Conclusion: Ductal component–containing histology is associated with inferior survival in patients with mHSPC treated with ARPI-based therapy. These findings support the role of histological subtype as a clinically meaningful factor for risk stratification in the contemporary treatment era. Keywords: ARPI, ductal component, metastatic hormone-sensitive prostate cancer, PSA kinetics, prognosis
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Aliyev V. Prognostic Impact of Ductal Component in Metastatic Hormone-Sensitive Prostate Cancer Treated with ARPI-Based Therapy. EJMI. 2026; 10(4): 491-499
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