Dr Olmos on the Prognostic Implications of Data From the CAPTURE Study for BRCA-Mutant mHSPC

"We have to monitor these patients more closely and maybe cannot rely solely on PSA [levels] because these patients tend to progress much earlier, even with lower PSA values. That is very important."

David Olmos, MD, PhD, medical oncologist, group leader, and distinguished investigator, Genetic, Genomics & Therapeutics in Prostate Cancer, at Instituto de Investigación Hospital 12 de Octubre in Madrid, discussed how findings from the prospective, multi-cohort CAPTURE study could inform future approaches to risk stratification and management strategies in metastatic hormone-sensitive prostate cancer (mHSPC).

The CAPTURE study revealed that patients with mHSPC harboring BRCA mutations experienced significantly poorer outcomes vs those who did not. Data presented at the 2025 ASCO Annual Meeting showed that their median radiographic progression-free survival (rPFS) was 13.6 months, notably shorter than the 30.4 months observed in those without BRCA mutations (HR, 2.4; 95% CI, 1.8-3.3; P < .001). Similarly, median overall survival (OS) was 26.2 months for BRCA-mutated patients vs 55.1 months for the wild-type group (HR, 2.7; 95% CI, 2.0-3.6; P < .001).

Olmos emphasized that despite potential responses to standard options, patients with homologous recombination repair (HRR) mutations like BRCA still face a poor prognosis, even with treatment intensification. A crucial insight is the much shorter interval from biochemical to radiographic progression and overall survival in BRCA-mutated patients, he noted. This necessitates closer monitoring, as relying solely on prostate-specific antigen (PSA) levels may be insufficient due to earlier progression even with lower PSA values, Olmos said.

Furthermore, the biology associated with HRR alterations, such as BRCA mutations, is more critical than simply counting metastases, Olmos asserted. These patients inherently have a poor prognosis, independent of other factors, underscoring the need to implement this knowledge in treatment decisions and research, he added. Olmos concluded that treatment intensification is essential for these patients, even when PARP inhibitors are unavailable.