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

Objectives: The objective of this study was to investigate the prognostic value of systemic inflammatory markers (SIMs)—namely, the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR)—on survival outcomes and treatment responses in patients with metastatic castration-resistant prostate cancer (mCRPC) receiving abiraterone (ABI) or enzalutamide (ENZA) therapy. Methods: In this two-center retrospective observational study, researchers analyzed clinical data from 106 patients diagnosed with mCRPC. The cut-offs for NLR and PLR were determined to be 2.83 and 156, respectively, and their effects on progression-free survival (PFS) and overall survival (OS) were evaluated using Kaplan–Meier and Cox regression analyses. Changes in SIMs before and after ABI/ENZA treatment were assessed using the Wilcoxon signed-rank test. Results: Lower NLR (≤2.83) and PLR (≤156) were significantly associated with longer PFS and OS; however, in multivariate analysis, only high PLR emerged as an independent adverse prognostic factor for OS (HR: 2.01; p = 0.026). Meanwhile, treatment response was an independent predictor of PFS, and no significant changes were observed in the mean platelet volume (MPV), platelet distribution width (PDW), or platelet–large cell ratio (P-LCR) after treatment. Conclusions: SIMs, 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.