TY  - EJOU
AU  - Lyu, Jingcheng 
AU  - Yue, Ruiyu 
AU  - Liu, Yukun 
AU  - Song, Bo 
AU  - Yang, Boyu 
AU  - Zhang, Fengbo 

TI  - Urinary exosomal AR-V7 as a predictive biomarker for treatment outcomes in castration-resistant prostate cancer
T2  - Canadian Journal of Urology

PY  - 
VL  - 
IS  - 
SN  - 1488-5581

AB  -  <b>Objective:</b> Androgen receptor splice variant 7 (AR-V7) has emerged as a resistance biomarker in castration-resistant prostate cancer (CRPC), yet non-invasive detection methods and its predictive value for first-line treatment selection remain insufficiently characterized. This study investigated the association between urinary exosomal AR-V7 expression and tumor aggressiveness, prognosis, and treatment outcomes in CRPC patients. <b>Methods:</b> This retrospective cohort study enrolled 69 newly diagnosed CRPC patients from two centers (January 2020–January 2026). Urinary exosomes were isolated by ultracentrifugation, and AR-V7 status was determined qualitatively using a TaqMan probe-based qPCR assay (positive: Ct ≤ 35). Survival outcomes were analyzed using multivariable Cox regression and formal interaction testing between AR-V7 status and treatment type (novel hormonal agents [NHA] vs. docetaxel). <b>Results:</b> A total of 28 patients (40.6%) were AR-V7-positive. The AR-V7(+) group exhibited significantly higher tumor risk grades, T stages, M stages, and Gleason scores compared with the AR-V7(−) group (all <i>p</i> &lt; 0.05). Multivariable Cox regression adjusting for treatment type, age, M stage, and Gleason score confirmed AR-V7 positivity as an independent prognostic factor for PFS (adjusted HR = 4.84, 95% CI: 2.23–10.48, <i>p</i> &lt; 0.001) and OS (adjusted HR = 9.34, 95% CI: 3.41–25.64, <i>p</i> &lt; 0.001). A significant treatment-by-biomarker interaction was observed (<i>p</i> &lt; 0.05). In the AR-V7(+) subgroup, NHA was associated with significantly worse outcomes compared with docetaxel (HR for NHA vs. docetaxel: 3.362, 95% CI: 1.476–7.659 for PFS; 9.193, 95% CI: 3.040–27.795 for OS). In the AR-V7(−) subgroup, docetaxel was associated with worse outcomes compared with NHA (HR for NHA vs. docetaxel: 0.458, 95% CI: 0.228–0.918 for PFS; 0.365, 95% CI: 0.144–0.930 for OS). <b>Conclusions:</b> Urinary exosomal AR-V7 is a promising non-invasive candidate predictive biomarker for CRPC treatment stratification. These exploratory findings require validation in larger, multicenter, prospective studies before clinical implementation.
KW  - castration resistant prostate cancer; exosome; docetaxel; novel hormone agent

DO  - 10.32604/cju.2026.084989