{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T19:13:01Z","timestamp":1788289981118,"version":"build-2803163510"},"reference-count":61,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"abstract":"<jats:sec>\n                    <jats:title>Background and Objective<\/jats:title>\n                    <jats:p>Treatment of metastatic hormone\u2010sensitive prostate cancer (mHSPC) has evolved from androgen\u2010deprivation therapy (ADT) alone to combination therapy with androgen receptor pathway inhibitors. Although apalutamide (APA), abiraterone (ABI), and enzalutamide (ENZA) improve outcomes when added to ADT, direct comparative trials between androgen receptor pathway inhibitor\u2010based doublets are lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Our systematic search was conducted on 22 September 2025, in PubMed, Embase, and the Cochrane Library databases. Studies including patients with mHSPC treated with APA, ABI, or ENZA plus ADT were eligible if they contained real\u2010world data and reported at least one outcome: overall survival (OS), PSA50, PSA90, PSA \u22640.2\u2009ng\/mL, time to castration\u2010resistant prostate cancer, biochemical progression\u2010free survival, grade\u2009\u22653 adverse events, or treatment discontinuation (TDC). Pooled hazard ratios (HRs) and odds ratios (ORs) were calculated using inverse variance random\u2010effects models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Findings and Limitations<\/jats:title>\n                    <jats:p>\n                      In total, 17 retrospective studies comprising 18\u2009626 patients were included. Compared with ABI, APA was associated with improved OS (HR 1.27; 95% confidence interval [CI] 1.09\u20131.47;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.002), PSA90 (OR 0.70; 95% CI 0.54\u20130.91;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.019), PSA\u2009&lt;0.2\u2009ng\/mL (OR 0.49; 95% CI 0.25\u20130.95;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.039), and castration\u2010resistant prostate cancer (HR 1.40; 95% CI 1.05\u20131.88;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.023). APA also demonstrated higher PSA90 response rates than ENZA (OR 0.67; 95% CI 0.5\u20130.9;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.017). TDC due to adverse events was lower with ABI than with APA (OR 0.56; 95% CI 0.37\u20130.86;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.029), with no significant difference between ENZA and APA (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.10).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and Clinical Implications<\/jats:title>\n                    <jats:p>In real\u2010world settings, APA\u2010based doublets were associated with more favourable efficacy outcomes with ABI, whereas ABI\u2010 and ENZA\u2010based regimens were associated with lower TDC rates. ABI and ENZA demonstrated comparable efficacy and safety profiles, supporting individualized ARPI selection in mHSPC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.70438","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T18:17:31Z","timestamp":1788286651000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative effectiveness of apalutamide\u2010, abiraterone\u2010, and enzalutamide\u2010based doublets in\n                    <scp>mHSPC<\/scp>"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-9709-0080","authenticated-orcid":false,"given":"Anik\u00f3 Katalin","family":"Valikovics","sequence":"first","affiliation":[{"name":"Centre for Translational Medicine Semmelweis University  Budapest Hungary"},{"name":"Department of Urology Semmelweis University  Budapest 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