Distinct Prognostic Roles of Grade Group and Intraductal Carcinoma of the Prostate in Metastatic Hormone‐Sensitive Prostate Cancer Treated With Androgen Receptor Signaling Inhibitors

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ABSTRACT Objectives The study aimed to evaluate the impact of grade group (GG) and intraductal carcinoma of the prostate (IDC‐P), as established prognostic factors, on clinical endpoints in metastatic hormone‐sensitive prostate cancer (mHSPC) patients treated with androgen receptor signaling inhibitors (ARSIs). Methods We retrospectively analyzed 147 patients with mHSPC treated with androgen deprivation therapy and ARSIs (abiraterone acetate, enzalutamide, or apalutamide). Associations between clinicopathological factors, including GG 5 and IDC‐P, and prostate‐specific antigen progression‐free survival (PSA‐PFS), cancer‐specific survival (CSS), and overall survival (OS) were evaluated by Kaplan–Meier analysis and Cox proportional hazards models. Results GG 5 was identified in 66% of patients, and IDC‐P was present in 51% of patients. GG 5 was an independent predictor of PSA‐PFS, whereas IDC‐P was not. In contrast, IDC‐P was independently associated with poorer CSS, while GG was not. Neither IDC‐P nor GG was significantly associated with OS. The combined evaluation of GG 5 and IDC‐P showed the best prognostic predictive ability for PSA‐PFS, CSS, and OS. Conclusions In patients with ARSI‐treated mHSPC, both GG 5 and IDC‐P are important prognostic factors, although they play distinct roles in predicting clinical outcomes.