---
title: "Chart-Derived Lee Score, Upfront ARSI Use, and Competing Mortality in Metastatic Hormone-Sensitive"
id: "pubmed-42533722"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42533722"
content_type: "clinical_feed_article"
specialty: "Oncology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42533722/"
doi: "10.1111/ggi.70720"
published_at: "2026-08-01T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Chart-Derived Lee Score, Upfront ARSI Use, and Competing Mortality in Metastatic Hormone-Sensitive
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42533722
- **Specialty:** [Oncology](https://medichelpline.com/clinical-feed/oncology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42533722/)
- **DOI:** [10.1111/ggi.70720](https://doi.org/10.1111%2Fggi.70720)
- **Published At:** 2026-08-01T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This retrospective study evaluated a full-component chart-derived **Lee score** and its association with upfront **androgen receptor signaling inhibitor (ARSI)** selection and competing mortality in men with **metastatic hormone-sensitive prostate cancer (mHSPC)**. - From 136 potentially eligible patients receiving docetaxel-free first-line therapy, 96 patients with complete pretreatment documentation of all four functional items were analyzed using the original 12-component point allocations; 40 patients were excluded for incomplete functional documentation. - Median age in the included cohort was 80 years and median chart-derived Lee score was 11. Thirty-three patients (34.4%) received upfront ARSI. - Adjusted Firth logistic regression (n = 91 in the adjusted model) showed a possible inverse association between higher Lee score and receipt of upfront ARSI (odds ratio per point 0.84; 95% CI 0.69–1.01; p = 0.066), interpreted as uncertain. - The reverse Kaplan–Meier estimate of median follow-up was 37 months. There were 29 deaths, of which 17 were from other (non–prostate cancer) causes. - In univariable cause-specific Cox analysis, a higher Lee score was associated with higher risk of other-cause death (hazard ratio per point 1.16; 95% CI 1.02–1.32; p = 0.028); Fine–Gray competing-risks analysis yielded a similar estimate. - Included and excluded patients differed in age, albumin, ARSI use, and observed follow-up, and the analysis was limited by the small item-complete subset and relatively few competing events; authors describe findings as exploratory. - The authors conclude that direct functional assessment should inform individualization of treatment intensity in older patients with mHSPC, given the score’s association with other-cause mortality and its possible inverse relation with treatment intensification.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliation * 1 Department of Urology, Kimitsu Chuo Byoin, Kisarazu, Chiba, Japan. * PMID: **42533722** * DOI: [ 10.1111/ggi.70720 ](https://doi.org/10.1111/ggi.70720) Item in Clipboard # Full-Component Chart-Derived Lee Score, Upfront Androgen Receptor Signaling Inhibitor Selection, and Competing Mortality in Metastatic Hormone-Sensitive Prostate Cancer Koichiro Kurokawa et al. Geriatr Gerontol Int. 2026 Aug. Show details Display options Display options Format Abstract PubMed PMID Geriatr Gerontol Int Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Geriatr+Gerontol+Int%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Geriatr+Gerontol+Int%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42533722/) . 2026 Aug;26(8):e70720. doi: 10.1111/ggi.70720. ### Authors [Koichiro Kurokawa](https://pubmed.ncbi.nlm.nih.gov/?term=Kurokawa+K&cauthor_id=42533722)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42533722/#short-view-affiliation-1 "Department of Urology, Kimitsu Chuo Byoin, Kisarazu, Chiba, Japan."), [Satoshi Yamamoto](https://pubmed.ncbi.nlm.nih.gov/?term=Yamamoto+S&cauthor_id=42533722)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42533722/#short-view-affiliation-1 "Department of Urology, Kimitsu Chuo Byoin, Kisarazu, Chiba, Japan."), [Keita Higa](https://pubmed.ncbi.nlm.nih.gov/?term=Higa+K&cauthor_id=42533722)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42533722/#short-view-affiliation-1 "Department of Urology, Kimitsu Chuo Byoin, Kisarazu, Chiba, Japan."), [Hiroki Bamba](https://pubmed.ncbi.nlm.nih.gov/?term=Bamba+H&cauthor_id=42533722)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42533722/#short-view-affiliation-1 "Department of Urology, Kimitsu Chuo Byoin, Kisarazu, Chiba, Japan."), [Sanji Kanaoka](https://pubmed.ncbi.nlm.nih.gov/?term=Kanaoka+S&cauthor_id=42533722)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42533722/#short-view-affiliation-1 "Department of Urology, Kimitsu Chuo Byoin, Kisarazu, Chiba, Japan."), [Kazuyoshi Nakamura](https://pubmed.ncbi.nlm.nih.gov/?term=Nakamura+K&cauthor_id=42533722)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42533722/#short-view-affiliation-1 "Department of Urology, Kimitsu Chuo Byoin, Kisarazu, Chiba, Japan.") ### Affiliation * 1 Department of Urology, Kimitsu Chuo Byoin, Kisarazu, Chiba, Japan. * PMID: **42533722** * DOI: [ 10.1111/ggi.70720 ](https://doi.org/10.1111/ggi.70720) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Aim:** To examine associations of a full-component chart-derived Lee score with upfront androgen receptor signaling inhibitor (ARSI) selection and competing mortality in men with metastatic hormone-sensitive prostate cancer (mHSPC). **Methods:** Of 136 potentially eligible patients receiving docetaxel-free first-line therapy, 96 with direct pretreatment documentation of all four functional items were included. The 12-component score used the original point allocations and was analyzed continuously. Upfront ARSI receipt was evaluated using adjusted Firth logistic regression. Other-cause mortality was assessed using univariable cause-specific Cox and Fine-Gray models. **Results:** Thirty-three patients (34.4%) received upfront ARSI. Median age was 80 years and median score was 11. In the adjusted model (n = 91), a higher score showed an uncertain inverse association with upfront ARSI receipt (odds ratio per point, 0.84; 95% confidence interval [CI], 0.69-1.01; p = 0.066). The reverse Kaplan-Meier estimate of median follow-up was 37 months. Twenty-nine deaths occurred, including 17 from other causes. In univariable Cox analysis, a higher score was associated with other-cause death (hazard ratio per point, 1.16; 95% CI, 1.02-1.32; p = 0.028), with a similar Fine-Gray estimate. Forty patients were excluded for incomplete functional documentation; included and excluded patients differed in age, albumin, ARSI use, and observed follow-up. **Conclusions:** The score showed a possible inverse relation with treatment intensification and was associated with other-cause mortality. Because the analysis used an item-complete subset with few competing events, the findings are exploratory. Direct functional assessment should inform treatment individualization. **Keywords:** Firth logistic regression; androgen receptor signaling inhibitor; competing risks; geriatric assessment; prostate cancer. © 2026 Japan Geriatrics Society. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Similar articles * [ Prognostic Impact of Initial Prostate-Specific Antigen in Metastatic Hormone-Sensitive Prostate Cancer Patients With Extensive Bone Metastases Under Androgen Receptor Signaling Inhibitor. ](https://pubmed.ncbi.nlm.nih.gov/40715014/) Fujimoto S, Morita T, Yamamoto Y, Saruta M, Yoshizawa A, Takahara K, Tsujino T, Maenosono R, Yoshikawa Y, Fukuokaya W, Yanagisawa T, Kimura T, Hashimoto T, Hirasawa Y, Ohno Y, Fujita K.Fujimoto S, et al.Prostate. 2025 Oct;85(14):1307-1314. doi: 10.1002/pros.70017. Epub 2025 Jul 27.Prostate. 2025.PMID: 40715014 * [ Evaluating CRPC Definition: Comparing Upfront ARSI and Conventional Hormonal Therapy for Metastatic Hormone Sensitive Prostate Cancer (mHSPC) in Real World Propensity Score Matched Cohort. ](https://pubmed.ncbi.nlm.nih.gov/40200561/) Shimomura T, Urabe F, Muramoto K, Yanagisawa T, Fukuokaya W, Mori K, Tashiro K, Katsumi K, Takahashi H, Yoshihara K, Miyajima K, Imai Y, Iwatani K, Kayano S, Igarashi T, Murakami M, Tsuzuki S, Yamada H, Miki J, Kimura T; JIKEI YAYOI Collaborative Group.Shimomura T, et al.Prostate. 2025 Jul;85(10):912-918. doi: 10.1002/pros.24898. 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Epub 2024 Oct 1.Int J Clin Oncol. 2024.PMID: 39352622 * [ Abiraterone acetate in combination with androgen deprivation therapy compared to androgen deprivation therapy only for metastatic hormone-sensitive prostate cancer. ](https://pubmed.ncbi.nlm.nih.gov/33314020/) Sathianathen NJ, Oestreich MC, Brown SJ, Gupta S, Konety BR, Dahm P, Kunath F.Sathianathen NJ, et al.Cochrane Database Syst Rev. 2020 Dec 12;12(12):CD013245. doi: 10.1002/14651858.CD013245.pub2.Cochrane Database Syst Rev. 2020.PMID: 33314020Free PMC article. * [ Androgen Receptor Signaling Inhibitors in Addition to Docetaxel with Androgen Deprivation Therapy for Metastatic Hormone-sensitive Prostate Cancer: A Systematic Review and Meta-analysis. ](https://pubmed.ncbi.nlm.nih.gov/35995644/) Yanagisawa T, Rajwa P, Thibault C, Gandaglia G, Mori K, Kawada T, Fukuokaya W, Shim SR, Mostafaei H, Motlagh RS, Quhal F, Laukhtina E, Pallauf M, Pradere B, Kimura T, Egawa S, Shariat SF.Yanagisawa T, et al.Eur Urol. 2022 Dec;82(6):584-598. doi: 10.1016/j.eururo.2022.08.002. Epub 2022 Aug 19.Eur Urol. 2022.PMID: 35995644 [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=42533722) ## References 1. 1. K. Fizazi, N. Tran, L. Fein, et al., “Abiraterone Plus Prednisone in Metastatic, Castration‐Sensitive Prostate Cancer,” New England Journal of Medicine 377 (2017): 352–360. 2. 1. N. D. James, J. S. de Bono, M. R. Spears, et al., “Abiraterone for Prostate Cancer Not Previously Treated With Hormone Therapy,” New England Journal of Medicine 377 (2017): 338–351. 3. 1. K. N. Chi, N. Agarwal, A. Bjartell, et al., “Apalutamide for Metastatic, Castration‐Sensitive Prostate Cancer,” New England Journal of Medicine 381 (2019): 13–24. 4. 1. I. D. Davis, A. J. Martin, M. R. Stockler, et al., “Enzalutamide With Standard First‐Line Therapy in Metastatic Prostate Cancer,” New England Journal of Medicine 381 (2019): 121–131. 5. 1. A. J. Armstrong, R. Z. Szmulewitz, D. P. Petrylak, et al., “ARCHES: A Randomized, Phase III Study of Androgen Deprivation Therapy With Enzalutamide or Placebo in Men With Metastatic Hormone‐Sensitive Prostate Cancer,” Journal of Clinical Oncology 37 (2019): 2974–2986. Show all 22 references ## MeSH terms * Aged Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Aged%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Aged) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42533722/) * Aged, 80 and over Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Aged%2C+80+and+over%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Aged%2C+80+and+over) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42533722/) * Androgen Receptor Antagonists* / therapeutic use Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Androgen+Receptor+Antagonists%2Ftherapeutic+use%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Androgen+Receptor+Antagonists) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42533722/) * Humans Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Humans%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Humans) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42533722/) * Male Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Male%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Male) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42533722/) * Neoplasm Metastasis Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Neoplasm+Metastasis%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Neoplasm+Metastasis) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42533722/) * Prostatic Neoplasms* / drug therapy Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Prostatic+Neoplasms%2Fdrug+therapy%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Prostatic+Neoplasms) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42533722/) * Prostatic Neoplasms* / mortality Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Prostatic+Neoplasms%2Fmortality%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Prostatic+Neoplasms) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42533722/) * Prostatic Neoplasms* / pathology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Prostatic+Neoplasms%2Fpathology%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Prostatic+Neoplasms) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42533722/) * Receptors, Androgen Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Receptors%2C+Androgen%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Receptors%2C+Androgen) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42533722/) * Retrospective Studies Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Retrospective+Studies%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Retrospective+Studies) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42533722/) * Signal Transduction Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Signal+Transduction%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Signal+Transduction) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42533722/) ## Substances * Androgen Receptor Antagonists Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.
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