{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T19:06:44Z","timestamp":1789672004508,"version":"4.0.1"},"reference-count":23,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000005","name":"U.S. Department of War","doi-asserted-by":"publisher","award":["W81XWH\u201022\u20101\u20100602"],"award-info":[{"award-number":["W81XWH\u201022\u20101\u20100602"]}],"id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000005","name":"U.S. Department of War","doi-asserted-by":"publisher","award":["W81XWH\u201022\u20102\u20100024"],"award-info":[{"award-number":["W81XWH\u201022\u20102\u20100024"]}],"id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000005","name":"U.S. Department of War","doi-asserted-by":"publisher","award":["PC210332"],"award-info":[{"award-number":["PC210332"]}],"id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Prostate"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Androgen receptor pathway inhibitors (ARPIs) such as abiraterone and enzalutamide are common therapies in the management of metastatic castration\u2010resistant prostate cancer (mCRPC). However, the comparative effectiveness of these oral ARPIs in frail and comorbid patient populations remains uncertain. This study aims to determine whether one ARPI is associated with longer overall survival (OS) than the other, expanding upon prior work through inclusion of a contemporary patient cohort and examination of how comorbidities influence OS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using data from the nationwide Veterans Affairs (VA) healthcare system, we identified 8859 veterans with mCRPC treated with either abiraterone or enzalutamide between September 2014 and September 2022. Patients with prior docetaxel exposure were excluded, and frailty was defined using the VA Frailty Index (VA\u2010FI). Analyses were weighted for clinical covariates, including age, race, and BMI, using IPTW. Kaplan\u2013Meier analysis was used to compare OS between treatment groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among frail patients with mCRPC, enzalutamide treatment was associated with longer OS compared to abiraterone (22.8 vs. 20.9 months,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001). Similarly, enzalutamide was associated with longer OS than abiraterone among patients with cardiovascular disease or diabetes (26.3 vs. 23.9 months,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.023) and among patients without cardiovascular disease or diabetes (30.0 vs. 28.0 months,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.019).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Enzalutamide was associated with improved OS compared to abiraterone in frail patients with mCRPC, regardless of comorbid cardiovascular disease or diabetes. These findings highlight the importance of considering specialized patient populations, including frailty and comorbidity profiles, in ARPI selection and clinical care.<\/jats:p>\n                    <jats:p>\n                      <jats:bold>Trial Registration:<\/jats:bold>\n                      NA\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pros.70247","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T18:30:59Z","timestamp":1789669859000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Survival Outcomes by Frailty and Comorbidities in Veterans Treated With Abiraterone and Enzalutamide for Metastatic Castration\u2010Resistant Prostate Cancer"],"prefix":"10.1002","author":[{"given":"Meghana","family":"Yellanki","sequence":"first","affiliation":[{"name":"VA Boston Healthcare System Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"La","sequence":"additional","affiliation":[{"name":"VA Boston Healthcare System Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danne C.","family":"Elbers","sequence":"additional","affiliation":[{"name":"VA Boston Healthcare System Boston Massachusetts USA"},{"name":"Boston University Chobanian &amp; Avedesian School of Medicine Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nhan V.","family":"Do","sequence":"additional","affiliation":[{"name":"VA Boston Healthcare System Boston Massachusetts USA"},{"name":"Boston University Chobanian &amp; Avedesian School of Medicine Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3658-1858","authenticated-orcid":false,"given":"Channing J.","family":"Paller","sequence":"additional","affiliation":[{"name":"VA Boston Healthcare System Boston Massachusetts USA"},{"name":"Department of Oncology Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8058-3423","authenticated-orcid":false,"given":"Nathanael R.","family":"Fillmore","sequence":"additional","affiliation":[{"name":"VA Boston Healthcare System Boston Massachusetts USA"},{"name":"Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6388-5553","authenticated-orcid":false,"given":"Martin W.","family":"Schoen","sequence":"additional","affiliation":[{"name":"VA St. Louis Healthcare System St. Louis Missouri USA"},{"name":"Division of Hematology\/Oncology, Department of Medicine Saint Louis University School of Medicine St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"issue":"10437","key":"e_1_2_12_2_1","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.1016\/S0140-6736(24)00651-2","article-title":"The Lancet Commission on Prostate Cancer: Planning for the Surge in Cases","volume":"403","author":"James N. D.","year":"2024","journal-title":"Lancet"},{"issue":"9","key":"e_1_2_12_3_1","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.3390\/biomedicines9091247","article-title":"Current and Emerging Therapies for Metastatic Castration\u2010Resistant Prostate Cancer (mCRPC)","volume":"9","author":"Henr\u00edquez I.","year":"2021","journal-title":"Biomedicines"},{"issue":"10","key":"e_1_2_12_4_1","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1016\/j.jval.2018.03.012","article-title":"Systematic Review and Network Meta\u2010Analysis of Treatments for Chemotherapy\u2010Naive Patients With Asymptomatic\/Mildly Symptomatic Metastatic Castration\u2010Resistant Prostate Cancer","volume":"21","author":"McCool R.","year":"2018","journal-title":"Value in Health"},{"issue":"3","key":"e_1_2_12_5_1","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1001\/jamaoncol.2020.6973","article-title":"Comparison of Systemic Treatments for Metastatic Castration\u2010Sensitive Prostate Cancer: A Systematic Review and Network Meta\u2010Analysis","volume":"7","author":"Wang L.","year":"2021","journal-title":"JAMA Oncology"},{"issue":"35","key":"e_1_2_12_6_1","doi-asserted-by":"crossref","first-page":"59690","DOI":"10.18632\/oncotarget.17741","article-title":"Comparing the Clinical Efficacy of Abiraterone Acetate, Enzalutamide, and Orteronel in Patients With Metastatic Castration\u2010Resistant Prostate Cancer by Performing a Network Meta\u2010Analysis of Eight Randomized Controlled Trials","volume":"8","author":"Kang M.","year":"2017","journal-title":"Oncotarget"},{"issue":"15","key":"e_1_2_12_7_1","doi-asserted-by":"crossref","first-page":"5032","DOI":"10.1200\/JCO.2021.39.15_suppl.5032","article-title":"Survival of Veterans Treated With Enzalutamide and Abiraterone in Advanced Prostate Cancer","volume":"39","author":"Schoen M. W.","year":"2021","journal-title":"Journal of Clinical Oncology"},{"issue":"15","key":"e_1_2_12_8_1","doi-asserted-by":"crossref","DOI":"10.1200\/JCO.2017.35.15_suppl.e16537","article-title":"Treatment Outcomes in Men With Metastatic Castration\u2010Resistant Prostate Cancer (mCRPC) and Cardiovascular Disorders or Diabetes: The Prostate Cancer Registry","volume":"35","author":"Lumen N.","year":"2017","journal-title":"Journal of Clinical Oncology"},{"issue":"1","key":"e_1_2_12_9_1","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1186\/s12877-017-0623-0","article-title":"Measuring Frailty in Clinical Practice: A Comparison of Physical Frailty Assessment Methods in a Geriatric Out\u2010Patient Clinic","volume":"17","author":"Pritchard J. M.","year":"2017","journal-title":"BMC Geriatrics"},{"issue":"15","key":"e_1_2_12_10_1","doi-asserted-by":"crossref","first-page":"3009","DOI":"10.1002\/cam4.4658","article-title":"Prognostic Value of the Veterans Affairs Frailty Index in Older Patients With Non\u2010Small Cell Lung Cancer","volume":"11","author":"Cheng D.","year":"2022","journal-title":"Cancer Medicine"},{"issue":"5","key":"e_1_2_12_11_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.jgo.2023.101520","article-title":"Frailty and Survival Among Veterans Treated With Abiraterone or Enzalutamide for Metastatic Castration\u2010Resistant Prostate Cancer","volume":"14","author":"Deol E. S.","year":"2023","journal-title":"Journal of Geriatric Oncology"},{"issue":"7","key":"e_1_2_12_12_1","doi-asserted-by":"crossref","DOI":"10.1200\/CCI.23.00085","article-title":"Development and Validation of a Tool to Identify Patients Diagnosed With Castration\u2010Resistant Prostate Cancer","volume":"7","author":"Candelieri\u2010Surette D.","year":"2023","journal-title":"JCO Clinical Cancer Informatics"},{"issue":"5","key":"e_1_2_12_13_1","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1200\/CCI.21.00030","article-title":"Ascertainment of Veterans With Metastatic Prostate Cancer in Electronic Health Records: Demonstrating the Case for Natural Language Processing","volume":"5","author":"Alba P. R.","year":"2021","journal-title":"JCO Clinical Cancer Informatics"},{"issue":"11","key":"e_1_2_12_14_1","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1097\/01.mlr.0000182534.19832.83","article-title":"Coding Algorithms for Defining Comorbidities in ICD\u20109\u2010CM and ICD\u201010 Administrative Data","volume":"43","author":"Quan H.","year":"2005","journal-title":"Medical Care"},{"issue":"11","key":"e_1_2_12_15_1","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2020.25826","article-title":"Evaluation of Fall and Fracture Risk Among Men With Prostate Cancer Treated With Androgen Receptor Inhibitors: A Systematic Review and Meta\u2010Analysis","volume":"3","author":"Myint Z. W.","year":"2020","journal-title":"JAMA Network Open"},{"issue":"2","key":"e_1_2_12_16_1","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1093\/annonc\/mdv542","article-title":"Efficacy and Safety of Enzalutamide in Patients 75 Years or Older With Chemotherapy\u2010Naive Metastatic Castration\u2010Resistant Prostate Cancer: Results From Prevail","volume":"27","author":"Graff J. N.","year":"2016","journal-title":"Annals of Oncology"},{"issue":"3","key":"e_1_2_12_17_1","doi-asserted-by":"crossref","first-page":"e645","DOI":"10.1016\/j.clgc.2017.12.007","article-title":"The Cardiovascular Toxicity of Abiraterone and Enzalutamide in Prostate Cancer","volume":"16","author":"Iacovelli R.","year":"2018","journal-title":"Clinical Genitourinary Cancer"},{"issue":"1","key":"e_1_2_12_18_1","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1111\/bcp.14972","article-title":"Hospitalization for Adverse Events Under Abiraterone or Enzalutamide Exposure in Real\u2010World Setting: A French Population\u2010Based Study on Prostate Cancer Patients","volume":"88","author":"Scailteux L. M.","year":"2022","journal-title":"British Journal of Clinical Pharmacology"},{"issue":"6","key":"e_1_2_12_19_1","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1200\/JCO.2020.38.6_suppl.70","article-title":"Association of Abiraterone and Higher Odds of Cardiac Complications Compared to Enzalutamide","volume":"38","author":"Cone E. B.","year":"2020","journal-title":"Journal of Clinical Oncology"},{"issue":"2","key":"e_1_2_12_20_1","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/j.eururo.2019.07.031","article-title":"Mortality and Hospitalization Risk Following Oral Androgen Signaling Inhibitors Among Men With Advanced Prostate Cancer by Pre\u2010Existing Cardiovascular omorbidities","volume":"77","author":"Lu\u2010Yao G.","year":"2020","journal-title":"European Urology"},{"issue":"12","key":"e_1_2_12_21_1","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1634\/theoncologist.2014-0167","article-title":"Use of Prednisone With Abiraterone Acetate in Metastatic Castration\u2010Resistant Prostate Cancer","volume":"19","author":"Auchus R. J.","year":"2014","journal-title":"Oncologist"},{"issue":"4","key":"e_1_2_12_22_1","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1080\/13696998.2019.1705313","article-title":"Real\u2010World Incidence and Burden of Adverse Events Among Non\u2010Metastatic Prostate Cancer Patients Treated With Secondary Hormonal Therapies Following Androgen Deprivation Therapy","volume":"23","author":"Shah A.","year":"2020","journal-title":"Journal of Medical Economics"},{"issue":"6","key":"e_1_2_12_23_1","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1200\/JCO.2022.40.6_suppl.092","article-title":"Hospitalizations and Common Infections Among Veterans Treated for Metastatic Prostate Cancer","volume":"40","author":"Riekhof F.","year":"2022","journal-title":"Journal of Clinical Oncology"},{"issue":"12","key":"e_1_2_12_24_1","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.1080\/17425255.2021.2027908","article-title":"Potential and Real Drug Interactions in Patients Treated With Abiraterone or Enzalutamide in Clinical Practice","volume":"17","author":"Vicente\u2010Valor J.","year":"2021","journal-title":"Expert Opinion on Drug Metabolism & Toxicology"}],"container-title":["The Prostate"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pros.70247","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pros.70247","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pros.70247","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T18:31:03Z","timestamp":1789669863000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pros.70247"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,17]]},"references-count":23,"alternative-id":["10.1002\/pros.70247"],"URL":"https:\/\/doi.org\/10.1002\/pros.70247","archive":["Portico"],"relation":{},"ISSN":["0270-4137","1097-0045"],"issn-type":[{"value":"0270-4137","type":"print"},{"value":"1097-0045","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,17]]},"assertion":[{"value":"2026-05-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-31","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"pros.70247"}}