AR-V7 expression in primary non-metastatic prostate cancer and its role in disease progression following initial therapy: a systematic review and meta-analysis

The prognostic role of androgen receptor variant 7 (AR-V7) in non-metastatic prostate cancer remains unclear. We conducted a systematic review and meta-analysis to evaluate its impact on primary treatment outcomes and disease progression. We systematically searched PubMed, Embase, and Cochrane Central for observational studies and randomized controlled trials (RCTs) comparing AR-V7-positive and AR-V7-negative patients with non-metastatic prostate cancer. The primary outcomes were overall survival (OS) and biochemical recurrence (BCR). Secondary outcomes, including progression-free survival (PFS), cancer-specific survival (CSS), and the incidence of castration-resistant prostate cancer (CRPC), were assessed as non-meta-analyzable endpoints. Hazard ratios (HRs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random effects model. Statistical analyses were conducted in Review Manager software (version). Seven studies were included, comprising 1,383 patients. AR-V7 expression was associated with significantly worse OS (HR 5.75; 95% CI 2.24–14.78; p<0.05) but showed no significant difference in BCR between groups (RR 4.81; 95% CI 0.88–26.35; p=0.07). Among the non-meta-analyzable secondary outcomes, individual studies suggested that AR-V7-positive patients had a higher risk of CRPC progression, shorter CSS, and reduced PFS compared to AR-V7-negative patients, but heterogeneity in study design and reporting precluded quantitative synthesis. AR-V7 expression is a negative prognostic marker in non-metastatic prostate cancer, associated with significantly reduced OS and increased CRPC progression. While no significant difference was observed in BCR, the trend suggests potential implications for disease monitoring. Further studies with standardized detection methods are needed to clarify AR-V7’s role in risk stratification and treatment decisions.