Real-World Overall Survival Comparison of Enzalutamide and Abiraterone In First- and Second-Line Setting of Metastatic Castration-Resistant Prostate Cancer

Prostate. 2025 Sep;85(12):1151-1154. doi: 10.1002/pros.24923. Epub 2025 Jun 8.

Abstract

Background: While their indications overlap, no clinical trials have compared abiraterone and enzalutamide for overall survival (OS) in mCRPC.

Methods: A large, country-wide health insurance database (2013-2023) was assessed for the OS comparison between abiraterone and enzalutamide.

Results: Overall, 3497 patients were identified with first- (n = 2215) or second-line (n = 1282) abiraterone or enzalutamide treatment (only 66 received both drugs sequentially). Enzalutamide-treated patients had longer OS both in the first- (HR:0.84; 95%CI:0.74-0.96; p = 0.008) and the second-line setting (HR:0.88; 95%CI:0.78-0.99; p = 0.043), respectively.

Conclusions: This health insurance-registry-based study suggests that, in the real-world mCRPC setting, enzalutamide is superior to abiraterone in terms of OS.

Keywords: ADT; ARPI; abiraterone; androgen deprivation therapy; antiandrogen; enzalutamide; mCRPC; prostate cancer; real‐world.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Androstenes* / therapeutic use
  • Antineoplastic Agents* / therapeutic use
  • Benzamides* / therapeutic use
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Metastasis
  • Nitriles
  • Phenylthiohydantoin* / analogs & derivatives
  • Phenylthiohydantoin* / therapeutic use
  • Prostatic Neoplasms, Castration-Resistant* / drug therapy
  • Prostatic Neoplasms, Castration-Resistant* / mortality
  • Prostatic Neoplasms, Castration-Resistant* / pathology
  • Registries
  • Survival Rate

Substances

  • enzalutamide
  • Nitriles
  • Benzamides
  • abiraterone
  • Phenylthiohydantoin
  • Androstenes
  • Antineoplastic Agents