Quality of Life and Psychological Factors in Patients with Metastatic Prostate Cancer Receiving Androgen Receptor–Targeted Therapies: A Prospective Cross-Sectional Real-World Study

Background and Objectives: Quality of life (QoL) has become an essential outcome in patients with metastatic prostate cancer, particularly in the era of androgen receptor (AR)-targeted therapies. Although these agents improve survival, their differential impact on QoL and the role of psychological factors remain incompletely understood. This study aimed to evaluate QoL, functional outcomes, and psychological status, and to identify factors associated with poor QoL in a real-world cohort. Materials and Methods: This prospective cross-sectional, single-center observational study included 130 patients with metastatic prostate cancer receiving AR-targeted therapies (abiraterone, enzalutamide, or apalutamide/darolutamide). QoL was assessed using the EORTC QLQ-C30 questionnaire, and psychological status was evaluated using the Hospital Anxiety and Depression Scale (HADS). Patients were stratified according to treatment groups, and comparisons were performed using appropriate statistical tests. Logistic regression analyses were conducted to determine factors independently associated with poor QoL. Results: Exploratory differences in global QoL were observed among treatment groups (p = 0.007), with lower global QoL scores in the abiraterone group and numerically higher emotional and cognitive functioning scores in the enzalutamide group. Symptom analysis demonstrated higher nausea/vomiting scores in the abiraterone group (p = 0.022), whereas other symptom domains were comparable across treatment groups. In multivariable analysis, anxiety (odds ratio [OR]: 6.62) and depression (OR: 3.40) were independently associated with poor QoL, while treatment type was not independently associated with poor QoL after multivariable adjustment. Conclusions: Although unadjusted QoL scores differed across AR-targeted therapy groups, psychological factors—particularly anxiety and depression—were significantly associated with poorer QoL in patients with metastatic prostate cancer. These findings highlight the importance of integrating routine psychosocial assessment and supportive care strategies into clinical practice to optimize patient-centered outcomes. However, given the cross-sectional and exploratory nature of the study, the findings should be interpreted cautiously.