Association of second-generation antiandrogens with cognitive and functional toxicities in randomized trials: meta-analysis

The use of second-generation antiandrogens (AAs: abiraterone, apalutamide, darolutamide, and enzalutamide) for prostate cancer is increasing. Retrospective evidence suggests an association between second-generation AAs and adverse cognitive and functional outcomes, but further data from prospective trials are needed. A systematic review and meta-analysis of 12 randomized clinical trials comprising 13,524 participants found an increased risk of cognitive toxic effects, fatigue, and falls among prostate cancer patients treated with second-generation AAs. These results were consistent when examining studies with traditional hormone therapies in both treatment arms.