The Prognostic Role of Systemic Inflammatory Markers Before Abiraterone/Enzalutamide Therapy in Metastatic Castration-Resistant Prostate Cancer

Objective: To investigate the prognostic value of systemic inflammatory markers (SIM)—namely neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ra-tio (PLR)—on survival outcomes and treatment response in patients with metastatic castration-resistant prostate cancer (mCRPC) receiving abiraterone (ABI) or enzalu-tamide (ENZA) therapy. Methods: This two-center retrospective observational study analyzed clinical data of 106 patients diagnosed with mCRPC. The cut-off values for NLR and PLR were deter-mined as 2.83 and 156, respectively. Their effects on progression-free survival (PFS) and overall survival (OS) were evaluated using Kaplan-Meier and Cox regression analyses. Changes in SIM before and after ABI/ENZA treatment were assessed using the Wilcoxon signed-rank test. Results: Lower NLR (≤2.83) and PLR (≤156) levels were significantly associated with longer PFS and OS. In multivariate analysis, only high PLR emerged as an independent adverse prognostic factor for OS (HR: 2.01; p=0.026). Treatment response was an inde-pendent predictor of PFS. No significant changes were observed in MPV, PDW, or P-LCR levels after treatment. Conclusion: SIM such as NLR and especially PLR may serve as practical and accessible tools for predicting survival in mCRPC patients. However, further prospective studies are warranted.