Retrospective comparison of outcomes with abiraterone acetate or enzalutamide for metastatic castration-resistant prostate cancer

Abiraterone acetate and enzalutamide are recommended as preferred treatments for metastatic castration-resistant prostate cancer (mCRPC), but differences in their relative efficacy are unclear due to a lack of head-to-head clinical trials. A multicenter retrospective cohort study among mCRPC patients from the US Department of Veterans Affairs health care system starting treatment with abiraterone acetate or enzalutamide from 2014 to 2022 compared outcomes. In this cohort study of 5779 patients (3584 starting with abiraterone acetate and 2195 starting with enzalutamide), initiation of enzalutamide was associated with small but statistically significant improvements in survival times compared with initiation of abiraterone acetate, with more prominent improvements in short-term outcomes and in patient subgroups with less aggressive prostate cancer. The authors conclude that these findings may provide guidance for treatment strategies for mCRPC patients.