{
  "abstract": "BackgroundProstate cancer enzalutamide treatment is approved at a standard dose of 160 mg daily. Concerns for real-world patients -- older and more fragile than those enrolled in clinical trials -- have prompted consideration of initiating treatment with lower doses, but the long-term efficacy of this approach remains unknown. We evaluate the long-term survival and longevity in patients treated with standard versus upfront low-dose enzalutamide.\n\nMethodsRetrospective analysis of 151 patients treated with enzalutamide (102 receiving 160 mg; 49 receiving [≤]80 mg) between 2014-2021 at the Centre Hospitalier Universitaire de Martinique, with complete follow-up through end of life (98.7% completeness of follow-up). Primary outcomes were overall survival (OS), progression-free survival (PFS), and longevity (attained age).\n\nResultsDoses [≤]80 mg were associated with longer median OS (36.3 vs. 20.7 months), improved restricted mean OS (difference of 0.7 years, p=0.05), and enhanced longevity (median 82.5 vs. 78.3 years, p=0.004). PSA response rate at 12 weeks was higher with lower-dose (71.4% vs. 48.8%, p=0.016). In multivariable models adjusted for prognostic factors, [≤]40 mg compared with 160 mg was non-inferior regarding OS (HR=0.61, 95% CI 0.36-1.06), superior regarding PFS (HR=0.59, 95% CI 0.35-0.99), and superior regarding longevity (HR=0.48, 95% CI 0.28- 0.84). Bone metastasis, poor performance status, PSA response, time to PSA nadir, and disease duration were independent predictors of outcomes. A post-hoc analysis revealed a strong association between dose and physician-prescribing profiles, ranging from \"endorse-lowest-dose\" to \"never-deviate-from-full-dose\".\n\nConclusionsLower doses of enzalutamide were non-inferior to full-dose. Dose-adapted strategies warrant further investigation.",
  "abstract_shown": true,
  "affiliations": [
    "Cancer Tech Care"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 2,
  "authors": [
    {
      "name": "O. Gorobets"
    },
    {
      "affs": [
        0
      ],
      "name": "V. Vinh-Hung"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/ad4fb65w84de6.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.08.28.26361616",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.08.28.26361616v1.full",
  "id": "ad4fb65w84de6",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.08.28.26361616v1",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "oncology"
    ],
    [
      "openalex",
      "2740|Prostate Cancer Treatment and Research"
    ]
  ],
  "openalex": "W7206169664",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.08.28.26361616v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-08-28",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/ad4fb65w84de6.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:34Z",
      "native_id": "10.64898/2026.08.28.26361616",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.08.28.26361616v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:oncology",
      "subfield": "oncology"
    }
  ],
  "title": "Non-inferior survival and enhanced longevity with initial low-dose versus full-dose enzalutamide: a single-centre real-world prostate cancer study",
  "title_text": "Non-inferior survival and enhanced longevity with initial low-dose versus full-dose enzalutamide: a single-centre real-world prostate cancer study",
  "type": "preprint",
  "updated_at": "2026-10-30T12:17:34Z",
  "url": "https://research.draconitic.com/paper/ad4fb65w84de6",
  "venue": "medRxiv",
  "versions": []
}