Retrospective cohort finds longer survival with androgen receptor inhibitors than abiraterone in mHSPC

Retrospective · JAMA Netw Open · 2026-10-21. Number 1 in the UrologyWatch Top 5 for October 21, 2026.

In a Flatiron Health database study of 3404 mHSPC patients, those treated with androgen receptor inhibitors (apalutamide or enzalutamide) had significantly longer median overall survival (67.9 months) than those treated with abiraterone (57.2 months) after inverse probability weighting.

Why it matters: Hypothesis generating given the retrospective design and absence of head-to-head randomized trials comparing these two drug classes directly in mHSPC.

Limitation: Retrospective electronic health record database study; residual confounding by indication and unmeasured variables cannot be excluded despite weighting.

Source: JAMA Netw Open · PubMed 42900475 · DOI 10.1001/jamanetworkopen.2026.39458

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