Quality-of-Life in CRPC Patients Treated With Enzalutamide Versus Abiraterone: Impact of Standard and Modified Dosing
In brief
Enzalutamide maintains QoL; standard-dose abiraterone leads to decline
In a randomized trial of 89 men per arm, enzalutamide did not change overall FACT-G quality-of-life scores, whereas abiraterone at the usual 1000 mg dose caused a gradual, statistically significant deterioration, especially in social and functional well-being. A reduced abiraterone dose (up to 750 mg) avoided this decline, suggesting dose adjustment may preserve QoL.
- Journal
- Clinical genitourinary cancer (Q1)
- Published
- 4 July 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Shuichi Tatarano, Kouji Izumi, Hideki Enokida, Takashi Shima, Yuki Kato, Koji Mita, et al.
- PMID
- 42509097
- DOI
- 10.1016/j.clgc.2026.102614
Why clinicians should know about it
- Picked for Urology (top studies of the week, 2 August 2026): Abiraterone deteriorates QoL versus enzalutamide in CRPC patients
Abstract
BACKGROUND: Head-to-head comparisons between enzalutamide (ENZ) and abiraterone plus prednisolone (ABI) have shown comparable survival benefits in patients with castration-resistant prostate cancer (CRPC). However, the quality of life (QoL) associated with these agents has not been directly compared. We conducted a sub-analysis to evaluate longitudinal changes in QoL within each treatment arm. METHODS: The ENABLE study for PCa, an investigator-initiated, multicenter, randomized controlled trial, was performed. Patient-reported QoL was assessed using the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire, including subscales of physical, social, emotional, and functional well-being, at predefined timepoints. RESULTS: A total of 89 patients were included in each arm, with 76 (ENZ) and 74 (ABI) responding to the questionnaires. There were no significant differences in time to prostate-specific antigen progression or overall survival between arms (P = .1694 and P = .6306). ENZ did not change the total FACT-G score during the treatment course (P = .9585), whereas ABI significantly and gradually deteriorated it (P = .0003). In the ABI arm, the standard dose (1000 mg/d) significantly deteriorated the total FACT-G score (n = 55, P = .0003), while the modified dose (≤ 750 mg/d) did not (n = 15, P = .1816). Subscale analysis showed that ENZ did not deteriorate any domains, whereas ABI significantly worsened social and functional well-being (P = .0128 and P = .0006, respectively). Further analysis revealed that the modified dose of ABI did not deteriorate social or functional well-being (P = .6549 and P = .5837, respectively) while the standard dose significantly worsened both (P = .0010 and P < .0001, respectively). CONCLUSIONS: ABI deteriorated QoL over time, with the standard dose being the main contributor. The modified dose of ABI may represent a better treatment option to preserve QoL.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.