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Introduction
Prostate Cancer (PC), the most common cancer in men, is the second leading cause of cancer-related deaths. At the time of diagnosis, between 6 and 44% of patients are found to have metastatic prostate cancer [1, 2–3]. In the United States, approximately 11% of men are expected to be diagnosed with prostate cancer at some point in their lives, with the incidence rate generally rising with age. The overall five-year survival rate is above 98% [4]. Surgical intervention, radiotherapy, and androgen deprivation therapy (ADT) are effective treatments in controlling the disease at the local stage. However, the progression to a metastatic stage is inevitable for some patients. Patients who experience recurrence after radical treatments are classified as having castration-sensitive prostate cancer (CSPC). In recurrent patients, ADT was initially the only treatment option. Over time, as ADT became ineffective in mCSPC patients, the combined use of systemic therapies was initiated, particularly to improve survival outcomes. These therapeutic modalities include docetaxel or new-generation hormonal agents such as enzalutamide, abiraterone, apalutamide and darolutamide [5]. Although a significant proportion of patients respond to treatment, many progress to a castration-resistant stage. At this stage, patients are considered to have metastatic castration-resistant prostate cancer (mCRPC).
Treatment selection has become a crucial factor in predicting treatment response and prognosis, as demonstrated by clinical studies. The Chemo-hormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer (CHAARTED) study established high-volume and low-volume disease criteria, defining high-volume disease as having four or more bone metastases, with at least one outside the axial skeleton and/or visceral organ metastases [6]. This study showed that docetaxel improved survival in high-volume patients, but not in those with low-volume disease. In the Leuprolide and Abiraterone in High-Risk Metastatic Hormone-Sensitive Prostate Cancer (LATITUDE) study, patients were categorized into high-risk and low-risk groups. High-risk patients were defined as those meeting at least two of the following criteria: I) Gleason score ≥ 8 from prostate biopsy, II) three or more bone metastases, III) visceral organ metastasis. The study found that abiraterone extended survival in high-risk patients [7]. Despite the improvements in survival with new treatments, there remains a need for a biomarker to predict treatment outcomes and prognosis in patients with metastatic disease.
Inflammation has a vital role in PC malignancy by causing DNA damage and...