Multicenter retrospective comparison of androgen receptor inhibitors for nonmetastatic castration-resistant prostate cancer

Novel androgen receptor inhibitors (ARIs; darolutamide, enzalutamide, and apalutamide) are standard-of-care treatments for nonmetatatic castration-resistant prostate cancer (nmCRPC). There are sparse data comparing their clinical use and tolerability. The retrospective DEAR cohort study reviewed medical records from the Precision Point Specialty network of US urology practices. Among the 870 included nmCRPC patients starting ARI treatment between August 2019 and April 2022, 362 (41.6%) received darolutamide, 382 (43.9%) received enzalutamide, and 126 (14.5%) received apalutamide. The primary endpoint was a composite of treatment discontinuation and progression to metastatic CRPC, whichever occurred first. The time to reach this composite endpoint was significantly longer with darolutamide than with enzalutamide or apalutamide. Also for both separate endpoints (discontinuation or progression) darolutamide was superior to enzalutamide and apalutamide. The authors conclude that darolutamide may be the preferred ARI for nmCRPC in clinical practice.