apalutamide vs. abiraterone

[SherryKahn]

My husband has been recommended ADT + abiraterone + prednisone for two years. My friend who is an oncologist suggested apalutamide instead as it doesn't need to be supplements with prednisone and has less side effects. Wanted your opinion.

[JohnInTheMiddle]

Powerful and effective therapies! But what about chemo? If you add ADT plus ARPI plus chemo that makes triplet therapy. And for people who are eligible the clinical studies show very clear and significant benefits. And do you have a medical oncologist or only a urologist?

[SherryKahn in reply to JohnInTheMiddle]

This is in addition to internal beam radiation and external. Stage 4A prostate cancer to pelvic lymph node. Dr hasn't suggested ARPI +Chemo as part of the first line of treatment. Shall I ask him to? I have ate of urologist oncologist. radiologist at Memorial Sloane.

[JohnInTheMiddle in reply to SherryKahn]

Not sure what your last sentence means - you should have a medical oncologist. Once there's metastasis especially. And because you only have a lymph node I think this means you should familiarize yourself with the phrase oligometastatic. My mets on diagnosis were up and down my spine and around my ribs etc. I suggest you read up on triplet therapy. But maybe with so little metastases maybe that's not necessary, I don't know.

[SherryKahn in reply to JohnInTheMiddle]

Sorry typo. I have a team of oncologist, radiologist. It is in the lymph node (possibly both but PSMA scan showed one) in the pelvic area and seminal vessel. PSMA scan showed no othe place.

[Tall_Allen]

There's nothing to show it has fewer side effects. The prednisone just replaces the natural cortisol that abi prevents -- it doesn't add extra.

[SherryKahn]

Thank you Tall!

[Concerned-wife in reply to SherryKahn]

My husband did the Abi, prednisone. It worked well but at 2 years we think it affected his adrenal system..he is on vacation from the drugs so we don’t know.. We actually wondered about asking about darolutamide.

[Grandpa4 in reply to Concerned-wife]

What does “affected the adrenal system mean”? That drug blocks adrenal function. That is its goal. Your adrenal glands can not produce glucocorticoid or testosterone on abiraterone. Hence the prednisone.

[Derf4223]

Cost may matter. Abiraterone is generic -- you can get 120 doses for about $100 from a variety of sources. Apalutamide's patent expires in 2033, and thus 120 doses list for a bit over $15K. Under insurance plans that make it a tier 5 drug the co-pay can be costly. Approval in countries with nationalized health systems may disallow it.

Review side effects and consider which is the least-bad choice for you.

[vintage42]

"... ADT + abiraterone + prednisone for two years... an oncologist suggested apalutamide instead as it doesn't need to be supplements with prednisone and has less side effects."

I don't know that Erleada (apalutamide) has less side effects than Abi + Pred, which I have used for 4 months. So far my effects are common and mild, while I read that many people are so affected by Erleada that they go on half-dose.

[Explorer08]

I’m on Xtandi and Orgovyx. Pleased with results so far. I was given a choice of anti-androgens and selected Xtandi because with that I could avoid prednisone. Zero copays starting in March since I am now on the catastrophic category under Part D.

[Jewelrylady]

my husband is on Lupron, abiraterone and prednisone. He was considered ogliometastatic and had SBRT. His PSA and testosterone are undetectable. Side effects have lessened since started meds a year ago. His doctor did not recommend chemotherapy.

[Snowmountain]

My relative has been on apalutamide (Erleada) plus Lupron for 18 months and his PSA remains undetectable, thankfully.

He has no significant health side effects from the medication. Here is a link to a recent study that shows the effectiveness of apalutamide. sciencedirect.com/science/a...

I am personally very grateful for the apalutamide and feel we're lucky that our oncologist prescribed it. You might want to consider going with it.