醋酸阿比特龙和恩杂鲁胺被推荐作为转移性去势抵抗性前列腺癌（mCRPC）的首选治疗方法，但由于缺乏头对头的临床试验，其相对疗效的差异尚不清楚。需要明确的指导来做出明智的 mCRPC 治疗选择。比较接受醋酸阿比特龙或恩杂鲁胺治疗的 mCRPC 患者的临床结果。这项回顾性、多中心队列研究包括美国退伍军人事务部医疗保健系统中开始接受以下治疗的 mCRPC 患者： 2014年1月1日至2022年10月30日期间服用醋酸阿比特龙或恩杂鲁胺。醋酸阿比特龙或恩杂鲁胺。该研究使用治疗加权的逆概率来平衡开始使用醋酸阿比特龙或恩杂鲁胺的患者之间的基线特征，并评估限制平均生存时间（RMST）差异治疗开始后不同时间点的总生存期 (OS)、前列腺癌特异性生存期 (PCS)、下次治疗转换或死亡时间 (TTS) 以及前列腺特异性抗原 (PSA) 反应时间 (TTR)。研究包括 5779 名患者（中位年龄 74.42 岁 [IQR，68.94-82.14 岁]）。中位随访时间为 38 至 60 个月。开始使用恩杂鲁胺的患者平均 OS 比开始使用醋酸阿比特龙的患者更长，RMST 分别为 24.29 个月（95% CI，23.58-24.99 个月）和 23.38 个月（95% CI，22.85-23.92 个月），并且 RMST 存在差异4 年时为 0.90 个月（95% CI，0.02-1.79 个月）。同样，开始恩杂鲁胺治疗的患者的 TTS 和 TTR 也得到改善，4 年时的 RMST TTS 延长了 1.95 个月（95% CI，0.92-2.99 个月），TTR 缩短了 3.57 个月（95% CI，1.76-5.38 个月）。 。对于 PCS，2 年时的 RMST 延长了 0.48 个月（95% CI，0.01-0.95 个月）。对亚组的检查发现，在未接受多西紫杉醇治疗的患者（1.14 个月；95% CI，0.19-2.10 个月）和 PSA 倍增时间为 3 个月或更长的患者（2.23 个月；2.23 个月；2.23 个月）中，恩杂鲁胺起始治疗与 OS 较长相关。 95% CI，0.81-3.66 个月），但在既往接受多西他赛治疗的患者中（-0.25 个月；95% CI，-2.59 至 2.09 个月）或 PSA 倍增时间少于 3 个月的患者（0.05 个月；95% CI，- 1.05 至 1.15 个月）。在这项针对 mCRPC 患者的队列研究中，与开始使用醋酸阿比特龙相比，开始使用恩杂鲁胺与 OS、PCS、TTS 和 TTR 的小幅但具有统计学意义的改善相关。这些改善在短期结果（包括 TTS 和 TTR）以及先前未使用多西他赛或 PSA 倍增时间超过 3 个月的患者亚组中更为显着。

Abiraterone acetate and enzalutamide are recommended as preferred treatments for metastatic castration-resistant prostate cancer (mCRPC), but differences in their relative efficacy are unclear due to a lack of head-to-head clinical trials. Clear guidance is needed for making informed mCRPC therapeutic choices.To compare clinical outcomes in patients with mCRPC treated with abiraterone acetate or enzalutamide.This retrospective, multicenter cohort study included patients with mCRPC in the US Department of Veterans Affairs health care system who initiated treatment with abiraterone acetate or enzalutamide between January 1, 2014, and October 30, 2022.Abiraterone acetate or enzalutamide.The study used inverse probability of treatment weighting to balance baseline characteristics between patients initiating abiraterone acetate or enzalutamide and evaluated restricted mean survival time (RMST) differences in overall survival (OS), prostate cancer-specific survival (PCS), time to next treatment switching or death (TTS), and time to prostate-specific antigen (PSA) response (TTR) at different time points after treatment initiation.The study included 5779 patients (median age, 74.42 years [IQR, 68.94-82.14 years]). Median follow-up was between 38 and 60 months. Patients initiating enzalutamide on average had longer OS than those initiating abiraterone acetate, with RMSTs of 24.29 months (95% CI, 23.58-24.99 months) and 23.38 months (95% CI, 22.85-23.92 months), respectively, and a difference in RMST of 0.90 months (95% CI, 0.02-1.79 months) at 4 years. Similarly, TTS and TTR were improved in patients initiating enzalutamide, with an RMST at 4 years of 1.95 months (95% CI, 0.92-2.99 months) longer for TTS and 3.57 months (95% CI, 1.76-5.38 months) shorter for TTR. For PCS, the RMST at 2 years was 0.48 months (95% CI, 0.01-0.95 months) longer. An examination of subgroups identified that enzalutamide initiation was associated with longer RMST in OS among patients without prior docetaxel treatment (1.14 months; 95% CI, 0.19-2.10 months) and in those with PSA doubling time of 3 months or longer (2.23 months; 95% CI, 0.81-3.66 months) but not among patients with prior docetaxel (-0.25 months; 95% CI, -2.59 to 2.09 months) or with PSA doubling time of less than 3 months (0.05 months; 95% CI, -1.05 to 1.15 months).In this cohort study of patients with mCRPC, initiation of enzalutamide was associated with small but statistically significant improvements in OS, PCS, TTS, and TTR compared with initiation of abiraterone acetate. The improvements were more prominent in short-term outcomes, including TTS and TTR, and in patient subgroups without prior docetaxel or with PSA doubling time longer than 3 months.