Prognostic impact of diabetes or hypertension in smokers with CRPC receiving enzalutamide or abiraterone.

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.