How I do it: Apalutamide use in non-metastatic castrate resistant prostate cancer.
Urologists have been using oral nonsteroidal antiandrogens (AA) for 30 years as a component of combined androgen blockade. In February 2018, a new third generation AA, apalutamide, became available for the first time for non-metastatic (M0) castrate resistant prostate cancer (CRPC). Apalutamide was found to delay the presence of metastases (metastases free survival-MFS) by approximately 2 years versus placebo in M0 CRPC. While overall survival benefit has yet to be established, the MFS benefit is clinically meaningful and urology practices should be equipped to manage patients using this new oral agent. Since the majority of patients remain under urologic care when this disease stage develops and because the drug is straightforward to administer, urology practices are ideal to identify and treat. The objective of this brief article is to discuss the typical patient profile for use of apalutamide and to review the pros and cons of use and common side effects and management.
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James H. Semans, M.D. Professor of Urologic Surgery, in the School of Medicine
Dr Judd Moul joined the Duke faculty in mid 2004 after a career in the US Army Medical Corps mainly at Walter Reed Army Medical Center. He is a retired colonel and a noted researcher and clinician in the area of prostate cancer and is a urologic oncologist. He served as the division chief of Duke Division of Urology from 2004 to 2011 and was named the James H Semans MD Professor of surgery in 2009 becoming Duke's first named endowed chair for urology. He was awarded the Gold Cystosco