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Updated: Jun 21, 2026
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A Bioluminescent and Fluorescent Orthotopic Syngeneic Murine Model of Androgen-dependent and Castration-resistant Prostate Cancer
Published on: March 6, 2018
Mortality in Castration Resistant Prostate Cancer Patients With and Without Pre-Existing Cardiovascular Disease
Ibrahim M Asiri1,2, Ronald C Chen3, Viraj Master4
1Saudi Food & Drug Authority, Riyadh, Saudi Arabia.
Pharmacoepidemiology and Drug Safety
|June 20, 2026
Summary
Men with castration-resistant prostate cancer (CRPC) receiving oral androgen receptor pathway inhibitors (ARPi) showed lower mortality rates compared to chemotherapy, regardless of pre-existing cardiovascular disease (CVD). This real-world evidence supports ARPi use in broader patient groups.
Area of Science:
- Oncology
- Cardiovascular Medicine
- Pharmacology
Background:
- Men with castration-resistant prostate cancer (CRPC) and cardiovascular disease (CVD) are often excluded from clinical trials.
- Oral androgen receptor pathway inhibitors (ARPi) are a key treatment for CRPC.
- Comparative effectiveness of ARPi versus chemotherapy in CRPC patients with comorbidities is not well-established.
Purpose of the Study:
- To compare all-cause and prostate cancer-specific mortality in CRPC patients treated with ARPi versus chemotherapy.
- To evaluate treatment outcomes in CRPC patients with and without pre-existing CVD.
- To provide real-world evidence for ARPi use in a broader CRPC population.
Main Methods:
- Retrospective cohort study using the Surveillance, Epidemiology, and End Results-Medicare Linked Database (2004-2015).
- Patients grouped by ARPi or chemotherapy treatment and presence of pre-existing CVD.
- Inverse probability treatment weights (IPTW)-adjusted Cox and Fine-Gray models used to assess mortality risks.
Main Results:
- Nearly 54.4% of the 1438 CRPC patients had pre-existing CVD, associated with higher mortality.
- ARPi treatment was significantly associated with lower all-cause mortality (IPTW-AHR 0.56) and prostate cancer-specific mortality (IPTW-AHR 0.48) compared to chemotherapy in patients with CVD.
- Similar significant reductions in all-cause (IPTW-AHR 0.49) and prostate cancer-specific mortality (IPTW-AHR 0.52) were observed with ARPi versus chemotherapy in patients without CVD.
Conclusions:
- Oral ARPi are associated with reduced all-cause and prostate cancer-specific mortality compared to chemotherapy in CRPC patients, both with and without pre-existing CVD.
- Findings support the use of ARPi in CRPC patients with comorbidities, expanding evidence beyond clinical trial populations.
- Observational nature necessitates caution due to potential residual confounding and unmeasured clinical differences.
