Prognostic impact of diabetes or hypertension in smokers with CRPC receiving enzalutamide or abiraterone
In brief
Diabetes or hypertension linked to worse prostate-cancer survival in smokers receiving enzalutamide
In a retrospective analysis of 161 castration-resistant prostate cancer patients who smoked, those with diabetes or hypertension had significantly poorer prostate-cancer specific survival than those without these conditions, an effect seen only with enzalutamide and not abiraterone. Smoking status alone did not affect outcomes, highlighting the need to manage metabolic disease in this subgroup.
- Journal
- International journal of clinical oncology (Q1)
- Published
- 19 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Takashi Fukagai, Kouji Izumi, Motoki Yamagishi, Takashi Shima, Yuki Kato, Koji Mita, et al.
- PMID
- 42762423
- DOI
- 10.1007/s10147-026-03178-w
Why clinicians should know about it
- Picked for Urology (top studies of the week, 20 September 2026): Diabetes/HT worsen survival in CRPC smokers on enzalutamide
- Picked for Surgical Oncology (top studies of the week, 20 September 2026): High-quality evidence in a top journal
Abstract
BACKGROUND: Smoking and lifestyle‑related diseases increase the risk of cancer incidence and progression, but their impact on castration‑resistant prostate cancer (CRPC) remains unclear. This study examined whether diabetes mellitus (DM), hypertension (HT), and smoking habit (SH) affect the prognosis of CRPC patients treated with enzalutamide (ENZ) or abiraterone plus prednisolone (ABI). METHODS: Using data from the ENABLE study for PCa, an investigator‑initiated, multicenter, randomized controlled trial, patients were retrospectively categorized into two groups based on SH. Subsequently, the impact of the absence or presence of either DM or HT and treatment arm (ENZ or ABI) on survival endpoints was investigated. RESULTS: A total of 178 patients were randomized and treated, of whom 161 had available SH information and were included in the analysis (84 SH- and 77 SH+). No significant differences in survival endpoints were observed between the SH- and SH+ groups. In the SH+ group, prostate cancer-specific survival (PCSS) was significantly worse in the with‑DM/HT group than in the no‑DM/HT group (p = 0.0215). Multivariate Cox analysis confirmed that the presence of DM or HT was an independent predictor of poor PCSS. Furthermore, a significant difference in PCSS between the no‑DM/HT and with‑DM/HT groups was observed in the ENZ arm (p = 0.0201), but not in the ABI arm. CONCLUSIONS: SH does not appear to influence the efficacy of ENZ or ABI therapy for CRPC; however, among SH+ patients, the presence of DM or HT was associated with poorer survival outcomes, particularly in those treated with ENZ.
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.