{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T18:54:41Z","timestamp":1790362481082,"version":"4.1.0"},"reference-count":30,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T00:00:00Z","timestamp":1786752000000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Urology"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Randomized clinical trials have shown that second\u2010generation androgen receptor signaling inhibitors (ARSIs) improve overall survival (OS) in metastatic castration\u2010sensitive prostate cancer (mCSPC). In Japan, combined androgen blockade (CAB) has been widely used as conventional hormonal therapy, unlike Western trials in which androgen deprivation therapy (ADT) alone was the primary comparator. Whether this treatment context influences the survival benefit of ARSI\u2010based therapy in Japanese clinical practice remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a systematic review and meta\u2010analysis of studies evaluating ARSI plus ADT versus conventional hormonal therapy (ADT alone or CAB) in Japanese patients with mCSPC. PubMed and Ichushi\u2010Web were searched through February 2026. Adjusted hazard ratios from multivariable or propensity score\u2013matched analyses were pooled using a random\u2010effects model. Risk of bias was assessed using ROBINS\u2010I.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fourteen studies were included. Eleven all\u2010comer mCSPC cohorts were included in the primary analysis. ARSI\u2010based therapy was associated with improved OS compared with conventional hormonal therapy (pooled hazard ratio 0.86, 95% confidence interval 0.77\u20130.96), with no heterogeneity (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%). The prediction interval was 0.76 to 0.98. Sensitivity and subgroup analyses, including CAB\u2010based comparator cohorts, showed consistent results.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ARSI\u2010based therapy was associated with a modest but consistent improvement in OS in Japanese mCSPC. The attenuated effect size compared with randomized trials may reflect multiple factors, including differences in baseline treatment strategies, subsequent therapies, healthcare systems, and study design. These findings highlight the importance of treatment context when interpreting randomized trial evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>This systematic review and meta\u2010analysis was conducted in accordance with the PRISMA 2020 statement and was registered in PROSPERO (registration number: CRD420261380244)<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/iju.70603","type":"journal-article","created":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T08:36:27Z","timestamp":1786782987000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Survival Benefit of\n                    <scp>ARSI<\/scp>\n                    Therapy in Japanese\n                    <scp>mCSPC<\/scp>\n                    : A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3599-2217","authenticated-orcid":false,"given":"Hiroaki","family":"Iwamoto","sequence":"first","affiliation":[{"name":"Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science  Kanazawa Ishikawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8480-9100","authenticated-orcid":false,"given":"Kouji","family":"Izumi","sequence":"additional","affiliation":[{"name":"Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science  Kanazawa Ishikawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0355-1005","authenticated-orcid":false,"given":"Tomohiro","family":"Hori","sequence":"additional","affiliation":[{"name":"Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science  Kanazawa Ishikawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9449-5421","authenticated-orcid":false,"given":"Takahiro","family":"Inaba","sequence":"additional","affiliation":[{"name":"Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science  Kanazawa Ishikawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2503-8908","authenticated-orcid":false,"given":"Ryunosuke","family":"Nakagawa","sequence":"additional","affiliation":[{"name":"Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science  Kanazawa Ishikawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2553-0497","authenticated-orcid":false,"given":"Taiki","family":"Kamijima","sequence":"additional","affiliation":[{"name":"Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science  Kanazawa Ishikawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2554-7048","authenticated-orcid":false,"given":"Tomoyuki","family":"Makino","sequence":"additional","affiliation":[{"name":"Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science  Kanazawa Ishikawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3936-7235","authenticated-orcid":false,"given":"Renato","family":"Naito","sequence":"additional","affiliation":[{"name":"Department of Integrative Cancer Therapy and Urology Kanazawa University Graduate School of Medical Science  Kanazawa Ishikawa 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