Beyond pairwise comparisons of androgen receptor signaling inhibitors in nonmetastatic castration-resistant prostate cancer

We read with interest the multicenter study by Ishimoto et al.1 of 198 Japanese patients receiving first-line enzalutamide or darolutamide for nonmetastatic castration-resistant prostate cancer (nmCRPC). The authors found no evidence of between-group differences in prostate-specific antigen (PSA) response, PSA progression, metastasis development, or adverse events after accounting for death as a competing risk. A contemporaneous 16-institution study from our group, which compared darolutamide (n = 92), apalutamide (n = 64), and enzalutamide (n = 187), provides complementary evidence.