Abstract: As an ultralow prostate-specific antigen (PSA) nadir (≤0.02 ng/ml) after apalutamide treatment for metastatic hormone-sensitive prostate cancer (mHSPC) was associated with the best oncological outcomes, the question arises as to whether this holds true for both synchronous and metachronous mHSPC. We addressed this knowledge gap using data from the FRAMCAP (Frankfurt Metastatic Cancer of the Prostate) database. In a cohort of 75 patients with synchronous mHSPC treated with apalutamide, 35% experienced a PSA decline to ≤0.02 ng/ml. Analysis of time to castration-resistant prostate cancer (CRPC) and overall survival (OS) revealed significant differences by PSA nadir category (p
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