{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T21:28:56Z","timestamp":1793654936635,"version":"4.5.1"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"vor","delay-in-days":137,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Bayer HealthCare Pharmaceuticals, Inc."}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Prostate Cancer Prostatic Dis"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The real-world retrospective DEAR study in patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) demonstrated darolutamide was associated with lower risks of discontinuation and progression to metastatic castration-resistant disease vs enzalutamide and apalutamide. This analysis expands on DEAR, including additional patients and follow-up, comparing prostate-specific antigen (PSA) response, metastasis-free survival (MFS), and overall survival (OS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>DEAR-EXT was a chart review of electronic medical records from patients in US urology practices who initiated androgen receptor inhibitors (ARIs) for nmCRPC from August 2019\u2013March 2023. Outcomes included time to initial drug discontinuation, time to metastatic castration-resistant prostate cancer (mCRPC), PSA response, MFS, OS, and safety. Adjusted Cox proportional hazards models were used for the primary analysis and inverse probability of treatment weighting and other sensitivity analyses were performed to evaluate the impact of potential selection bias and confounding factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patients (N\u2009=\u20091375) received darolutamide (n\u2009=\u2009565, 41%), enzalutamide (n\u2009=\u2009609, 44%), or apalutamide (n\u2009=\u2009201, 15%). Baseline characteristics were mainly similar across groups. Adjusted risk of discontinuation was significantly lower with darolutamide vs enzalutamide (hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.61\u20130.88) and vs apalutamide (HR 0.69, 95% CI 0.54\u20130.89). Adjusted risk of progression to mCRPC was lower with darolutamide vs enzalutamide (HR 0.63, 95% CI 0.50\u20130.80) and vs apalutamide (HR 0.72, 95% CI 0.53\u20130.98). MFS was significantly longer for darolutamide vs enzalutamide (HR 0.65, 95% CI 0.53\u20130.79) and vs apalutamide (HR 0.72, 95% CI 0.55\u20130.93). The estimated MFS rates at 24\/36 months were 72.3%\/60.2% with darolutamide, 59.2%\/48.3% with enzalutamide, and\u00a063.9%\/47.6% with apalutamide. Darolutamide appeared to be associated with higher PSA response, improved survival, and fewer adverse events vs other ARIs in a real-world setting. Results were consistent in a\u00a0sensitivity analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Darolutamide demonstrated lower discontinuation rates, longer time to progression, and longer MFS vs other ARIs, highlighting its potential to enhance real-world patient outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov identifier: NCT06013475.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1038\/s41391-026-01099-3","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T05:22:47Z","timestamp":1773811367000},"page":"982-989","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Real-world analysis of androgen receptor inhibitors in US patients with nonmetastatic castration-resistant prostate cancer: DEAR-EXT study"],"prefix":"10.1038","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5767-0548","authenticated-orcid":false,"given":"Neal D.","family":"Shore","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0836-8542","authenticated-orcid":false,"given":"Daniel J.","family":"George","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nasreen","family":"Khan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niculae","family":"Constantinovici","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guifang","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mercedeh","family":"Ghadessi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vlasta","family":"Hlebec","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6563-4587","authenticated-orcid":false,"given":"Alicia K.","family":"Morgans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"1099_CR1","doi-asserted-by":"publisher","first-page":"1082","DOI":"10.1097\/JU.0000000000003452","volume":"209","author":"W Lowrance","year":"2023","unstructured":"Lowrance W, Dreicer R, Jarrard DF, Scarpato KR, Kim SK, Kirkby E, et al. 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Figure 11 has been renumbered as figure 10. Also related texts in the main texts were updated.","order":8,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"NDS: Consulting or advisory role: AbbVie, Alkido, Amgen, Arquer Diagnostics, Asieris Pharmaceuticals, Astellas, AstraZeneca, Bayer, Boston Scientific, Bristol Myers Squibb\/Sanofi, CG Oncology, Clarity Pharmaceuticals, Clovis Oncology, Dendreon, Exact Imaging, Exact Sciences, FerGene, Ferring, Foundation Medicine, GenesisCare, Genzyme, Guardant Health, ImmunityBio, Incyte, Invitae, Janssen Scientific Affairs, Lantheus, Lilly, MDxHealth, Medivation\/Astellas, Merck, Minomic, Myovant Sciences, Myriad Genetics, NGM Biopharmaceuticals, Nonagen Bioscience, Novartis, Nymox, Pacific Edge Biotechnology, PeerView, Pfizer, Phosphorus, Photocure, PlatformQ Health, Profound Medical, Promaxo, Propella Therapeutics, Protara Therapeutics, Sanofi, Sesen Bio, Specialty Networks, Telix Pharmaceuticals, Tempus, Tolmar, UroGen Pharma, Vaxiion, Vessi Medical; Leadership: Alessa Therapeutics, Photocure; Speakers\u2019 bureau: Astellas, AstraZeneca, Bayer, Clovis Oncology, Dendreon, Foundation Medicine, Guardant Health, Janssen, Merck, Pfizer; Expert testimony: Ferring; Other relationship: Alessa Therapeutics, Photocure; Research funding: AbbVie, Advantagene, Amgen, Aragon Pharmaceuticals, Astellas, AstraZeneca, Bayer, Boston Scientific, Bristol Myers Squibb\/Pfizer, CG Oncology, Clovis Oncology, Dendreon, DisperSol, Endocyte, Exact Imaging, Exelixis, Ferring, FKD Therapies, Forma Therapeutics, Foundation Medicine, Genentech, Guardant Health, Invitae, Istari Oncology, Janssen, Jiangsu Yahong Meditech, MDxHealth, Medivation, Merck, MT Group, Myovant Sciences, Myriad Genetics, Novartis, Nymox, OncoCell MDx, ORIC Pharmaceuticals, Pacific Edge Biotechnology, Palette Life Sciences, Pfizer, Plexxikon, POINT Biopharma, Propella Therapeutics, RhoVac, Sanofi, Seattle Genetics, Sesen Bio, Steba Biotech, Theralase, Tolmar, UroGen Pharma, Veru, Zenflow. DJG: Consulting or advisory role: Astellas, AstraZeneca, Bayer, Bristol Myers Squibb, Constellation Pharmaceuticals, Exelixis, Genentech, Innocrin Pharma, Janssen, Merck Sharp & Dohme, Michael J. Hennessy Associates, Myovant Sciences, Pfizer, Physicians\u2019 Education Resource, Propella Therapeutics, RevHealth, Sanofi, xCures; Leadership: Capio Biosciences; Speakers\u2019 bureau: Bayer, Exelixis, Sanofi; Travel, accommodations, expenses: Bayer, Exelixis, Janssen Oncology, Merck, Pfizer, Sanofi, UroToday; Honoraria: Acceleron Pharma, American Association for Cancer Research, Axess Oncology, Bayer, EMD Serono, Exelixis, Janssen Oncology, Millennium Medical Publishing, OncLive, Pfizer, Sanofi, UroToday; Research funding: Acerta Pharma, Astellas, Bayer, Bristol Myers Squibb, Calithera Biosciences, Dendreon, Exelixis, Innocrin Pharma, Janssen Oncology, Novartis, Pfizer, Sanofi\/Aventis. NK: Employment: Bayer; Consulting or advisory role: RWE consultant (self and immediate family member); Travel, accommodations, expenses: Bayer (self and immediate family member). NC: Employment: Bayer; Stock and other ownership interests: Bayer. GC: Employment: Bayer. MG: Employment: Bayer. VH: Employment: Bayer. AKM: Consulting or advisory role: Advanced Accelerator Applications, AstraZeneca, Astellas, Bayer, Blue Earth Diagnostics, Exelixis, Janssen, Lantheus Medical Imaging, Merck, Myovant Sciences, Myriad Genetics, Novartis; Travel, accommodations, expenses: Sanofi; Honoraria: Advanced Accelerator Applications, Astellas, Astellas Scientific and Medical Affairs, Inc, AstraZeneca, Bayer, Clovis Oncology, Exelixis, Genentech, Janssen, Janssen Oncology, Merck, Myovant Sciences, Pfizer, Sanofi; Research funding: Astellas Scientific and Medical Affairs, Inc, AstraZeneca, Bayer, Dendreon, Genentech, Myovant Sciences, Sanofi, Seattle Genetics\/Astellas.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"The study received central institutional review board approval.","order":2,"name":"Ethics","label":"Ethics approval statement","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"As a secondary data analysis of de-identified patient data, no patient informed consent was required.","order":3,"name":"Ethics","label":"Patient consent statement","group":{"name":"EthicsHeading","label":"Ethics"}}]}}