{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T01:47:20Z","timestamp":1782265640953,"version":"3.54.5"},"reference-count":25,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,21]],"date-time":"2026-06-21T00:00:00Z","timestamp":1782000000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Enzalutamide and abiraterone acetate are commonly used androgen receptor pathway inhibitors in metastatic castration-resistant prostate cancer (mCRPC), including after docetaxel. However, real-world outcomes remain heterogeneous, and simple prognostic markers may help describe this variability. This study aimed to describe survival outcomes with enzalutamide and abiraterone acetate after docetaxel and to explore the prognostic value of a routine clinical-inflammatory risk classification. Methods: This retrospective single-center study included 136 patients with mCRPC treated with enzalutamide or abiraterone acetate after docetaxel. A composite risk classification was defined using four routinely available variables: pan-immune-inflammation value (PIV) &gt; 457.99, time to castration resistance &lt; 12 months, baseline hemoglobin \u2264 12 g\/dL, and Gleason score \u2265 8. One point was assigned for each adverse factor, and patients were classified as low, moderate, or high risk. Overall survival (OS) was assessed using Kaplan\u2013Meier estimates and Cox regression. The prognostic score and Cox regression-based nomogram were evaluated as exploratory tools. Results: Of the 136 patients, 8 (5.9%) were classified as low risk, 67 (49.3%) as moderate risk, and 61 (44.9%) as high risk. Median OS was not reached in the low-risk group, compared with 33.84 months in the moderate-risk group and 9.66 months in the high-risk group. In multivariable analysis, high-risk status was independently associated with worse OS (HR = 9.87; 95% CI: 2.38\u201340.92; p = 0.002). No statistically significant OS difference was observed between enzalutamide and abiraterone acetate in this non-randomized cohort (HR = 1.36; 95% CI: 0.90\u20132.06; p = 0.142). Conclusions: In this real-world post-docetaxel mCRPC cohort, no statistically significant OS difference was observed between enzalutamide and abiraterone acetate; however, the study was not designed to establish comparative effectiveness or therapeutic equivalence. The exploratory risk classification based on routine clinical and inflammatory variables was associated with distinct survival outcomes. External validation is required before clinical application.<\/jats:p>","DOI":"10.3390\/jcm15124816","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T01:03:23Z","timestamp":1782263003000},"page":"4816","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Enzalutamide Versus Abiraterone After Docetaxel in Metastatic Castration-Resistant Prostate Cancer: Real-World Outcomes and Exploratory Prognostic Stratification"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3653-4429","authenticated-orcid":false,"given":"Mert","family":"Tohumcuo\u011flu","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Adana City Training and Research Hospital, University of Health Sciences, Adana 01230, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tolga","family":"K\u00f6\u015feci","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Faculty of Medicine, \u00c7ukurova University, Adana 01330, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2994-9191","authenticated-orcid":false,"given":"Alpay","family":"D\u00fc\u015fg\u00fcn","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Adana City Training and Research Hospital, University of Health Sciences, Adana 01230, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah Evren","family":"Yeti\u015fir","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Adana City Training and Research Hospital, University of Health Sciences, Adana 01230, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5986-5493","authenticated-orcid":false,"given":"Cem","family":"Mirili","sequence":"additional","affiliation":[{"name":"Medical Oncology Clinic, Adana Ortado\u011fu Hospital, Adana 01140, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0780-6176","authenticated-orcid":false,"given":"Burak","family":"Mete","sequence":"additional","affiliation":[{"name":"Department of Public Health, Faculty of Medicine, \u00c7ukurova University, Adana 01330, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6356-9059","authenticated-orcid":false,"given":"Mahmut","family":"B\u00fcy\u00fck\u015fim\u015fek","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Adana City Training and Research Hospital, University of Health Sciences, Adana 01230, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,21]]},"reference":[{"key":"ref_1","first-page":"229","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1200\/JCO.2015.64.2702","article-title":"Trial design and objectives for castration-resistant prostate cancer: Updated recommendations from the Prostate Cancer Clinical Trials Working Group 3","volume":"34","author":"Scher","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1502","DOI":"10.1056\/NEJMoa040720","article-title":"Docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer","volume":"351","author":"Tannock","year":"2004","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1995","DOI":"10.1056\/NEJMoa1014618","article-title":"Abiraterone and increased survival in metastatic prostate cancer","volume":"364","author":"Logothetis","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1016\/S1470-2045(12)70379-0","article-title":"Abiraterone acetate for treatment of metastatic castration-resistant prostate cancer: Final overall survival analysis of the COU-AA-301 randomised, double-blind, placebo-controlled phase 3 study","volume":"13","author":"Fizazi","year":"2012","journal-title":"Lancet Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1056\/NEJMoa1207506","article-title":"Increased survival with enzalutamide in prostate cancer after chemotherapy","volume":"367","author":"Scher","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_7","unstructured":"Cornford, P., Tilki, D., van den Bergh, R.C.N., Eberli, D., Fonteyne, V., Gandaglia, G., Gillessen, S., Henry, A.M., van Leenders, G.J.L.H., and Oldenburg, J. (2026). EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer, EAU Guidelines Office. Available online: https:\/\/uroweb.org\/guidelines\/prostate-cancer."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1730","DOI":"10.1016\/S1470-2045(19)30688-6","article-title":"Optimal sequencing of enzalutamide and abiraterone acetate plus prednisone in metastatic castration-resistant prostate cancer: A multicentre, randomised, open-label, phase 2, crossover trial","volume":"20","author":"Khalaf","year":"2019","journal-title":"Lancet Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"14131","DOI":"10.1038\/s41598-021-93659-x","article-title":"Comparison of real-life data of abiraterone acetate and enzalutamide in metastatic castration-resistant prostate cancer","volume":"11","author":"Demirci","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1038\/s41391-024-00816-0","article-title":"Real-world overall survival with abiraterone acetate versus enzalutamide in chemotherapy-na\u00efve patients with metastatic castration-resistant prostate cancer","volume":"27","author":"George","year":"2024","journal-title":"Prostate Cancer Prostatic Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1038\/s41391-022-00588-5","article-title":"Survival of veterans treated with enzalutamide and abiraterone for metastatic castrate resistant prostate cancer based on comorbid diseases","volume":"26","author":"Schoen","year":"2023","journal-title":"Prostate Cancer Prostatic Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/j.euo.2025.06.008","article-title":"Evaluating Treatment Efficacy in Metastatic Hormone-Sensitive Prostate Cancer Patients with Visceral Disease: A Systematic Review and Network Meta-Analysis","volume":"9","author":"Flauto","year":"2026","journal-title":"Eur. Urol. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1200\/JCO.2013.52.3696","article-title":"Updated prognostic model for predicting overall survival in first-line chemotherapy for patients with metastatic castration-resistant prostate cancer","volume":"32","author":"Halabi","year":"2014","journal-title":"J. Clin. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1093\/annonc\/mdv594","article-title":"A prognostic index model for predicting overall survival in patients with metastatic castration-resistant prostate cancer treated with abiraterone acetate after docetaxel","volume":"27","author":"Chi","year":"2016","journal-title":"Ann. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2200","DOI":"10.1093\/annonc\/mdy406","article-title":"Development and validation of a prognostic model for overall survival in chemotherapy-na\u00efve men with metastatic castration-resistant prostate cancer","volume":"29","author":"Armstrong","year":"2018","journal-title":"Ann. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1652","DOI":"10.1200\/JCO.2015.65.7270","article-title":"Meta-analysis evaluating the impact of site of metastasis on overall survival in men with castration-resistant prostate cancer","volume":"34","author":"Halabi","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_17","first-page":"1475","article-title":"Time to castration resistance is an independent predictor of castration-resistant prostate cancer survival","volume":"31","author":"Bournakis","year":"2011","journal-title":"Anticancer Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2672","DOI":"10.1038\/s41598-023-29634-5","article-title":"Low hemoglobin and PSA kinetics are prognostic factors of overall survival in metastatic castration-resistant prostate cancer patients","volume":"13","author":"Hakozaki","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1378","DOI":"10.1007\/s12094-019-02274-w","article-title":"Age, Gleason score, and PSA are important prognostic factors for survival in metastatic castration-resistant prostate cancer. Results of the Uroncor Group (Uro-Oncological Tumors) of the Spanish Society of Radiation Oncology (SEOR)","volume":"22","author":"Valero","year":"2020","journal-title":"Clin. Transl. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1038\/s41416-020-0894-7","article-title":"The pan-immune-inflammation value is a new prognostic biomarker in metastatic colorectal cancer: Results from a pooled analysis of the Valentino and TRIBE first-line trials","volume":"123","author":"Fuca","year":"2020","journal-title":"Br. J. Cancer"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1456","DOI":"10.1002\/pros.24419","article-title":"Prognostic role of pan-immune-inflammation value in patients with metastatic castration-resistant prostate cancer treated with androgen receptor-signaling inhibitors","volume":"82","author":"Yazgan","year":"2022","journal-title":"Prostate"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1002\/pros.24923","article-title":"Real-world overall survival comparison of enzalutamide and abiraterone in first- and second-line setting of metastatic castration-resistant prostate cancer","volume":"85","author":"Blasszauer","year":"2025","journal-title":"Prostate"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Aprikian, A., Bahl, A., Omlin, A., Baciarello, G., Chakravarty, A., Kondaparthi, P., Gourgioti, G., McLean, T., Serikoff, A., and Chilelli, A. (2025). Meta-analysis to evaluate the comparative effectiveness of enzalutamide and abiraterone acetate for first-line treatment of metastatic castration-resistant prostate cancer in real-world settings. Front. Oncol., 15.","DOI":"10.3389\/fonc.2025.1491314"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1002\/pros.24804","article-title":"The prognostic role of pan-immune inflammation value in patients with metastatic castration resistance prostate cancer treated with Lutetium-177 (177Lu)-PSMA-617","volume":"85","author":"Yazgan","year":"2025","journal-title":"Prostate"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Kawahara, T., Saigusa, Y., Yoneyama, S., Kato, M., Kojima, I., Yamada, H., Kamihira, O., Tabata, K., Tsumura, H., and Iwamura, M. (2023). Development and validation of a survival nomogram and calculator for male patients with metastatic castration-resistant prostate cancer treated with abiraterone acetate and\/or enzalutamide. BMC Cancer, 23.","DOI":"10.1186\/s12885-023-10700-0"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4816\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T01:27:46Z","timestamp":1782264466000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4816"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,21]]},"references-count":25,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15124816"],"URL":"https:\/\/doi.org\/10.3390\/jcm15124816","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,21]]}}}