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Advanced prostate cancer is usually detected late or at a more aggressive clinical stage. Treatment options include higher-risk surgery, radiotherapy, hormone therapy or chemotherapy.

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After using hormone therapy for a couple of months or even years, prostate cancer can recur when it becomes resistant to this treatment, despite applying the correct hormone therapy. This is called castrate-resistant prostate cancer (CRPC).

During CRPC, aggressive prostate cancer cells can remain within the prostate gland only (non-metastatic), or spread outside the prostate to other parts of the body (metastatic). For men with non-metastatic CRPC, one key treatment goal is to prevent the cancer cells from spreading to become metastatic.

Currently, there are new innovations to improve treatment for men with non-metastatic CRPC called second-generation androgen receptor antagonists (e.g., darolutamide, apalutamide and enzalutamide). They improve prostate cancer care when added to standard hormone therapy for these men. All 3 medicines improve survival and reduce the spread of cancer but the side effects associated with each medicine may be different.

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Darolutamide

In the ARAMIS phase 3 clinical study , when compared to placebo, more men taking darolutamide stayed alive and were less likely to have worsening pain. In its final analysis, when compared to placebo, men who took darolutamide had lower risk of death.

The incidence of adverse events after the start of treatment was similar in the two groups. Some side effects include fatigue, hypertension, fractures and falls.

Enzalutamide

In the PROSPER phase 3 clinical study, when compared to placebo, more men taking enzalutamide stayed alive and were without cancer spread when compared to placebo. In its final analysis, when compared to placebo, men who took enzalutamide had lower risk of death.

Common side effects after taking enzalutamide include severe fatigue, falls, dizziness, hypertension and death from cardiovascular disease.

Apalutamide

In the SPARTAN phase 3 clinical study, more men taking apalutamide stayed alive when compared to placebo. In the final analysis of this study, when compared to placebo, taking apalutamide leads to them living longer.

Common side effects for apalutamide include fatigue, skin rashes, hypertension, fractures and falls.

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