What is Apalutamide, and how does it work?
Apalutamide (Erleada®) is a type of hormone therapy used to treat prostate cancer. It works by blocking the effects of testosterone, a hormone that prostate cancer cells need to grow. While it doesn't cure prostate cancer, it helps keep the disease under control and delays its spread, which can postpone the need for further treatments such as chemotherapy.
Who is Apalutamide suitable for?
Apalutamide is suitable for men with:
- Localised or locally advanced prostate cancer that has stopped responding to other hormone therapies (non-metastatic castration-resistant prostate cancer).
In England, Wales, and Northern Ireland, it’s offered if there's a high risk of the cancer spreading, indicated by a PSA doubling time of 10 months or less.
- Newly diagnosed advanced prostate cancer (metastatic hormone-sensitive prostate cancer) that is likely to respond to hormone therapy.
When might my doctor recommend Apalutamide as a first treatment?
You may be offered Apalutamide as a first treatment for advanced prostate cancer if:
- You have never had hormone therapy before, or have had no more than three months of hormone therapy.
- You cannot undergo chemotherapy with docetaxel.
Inform your healthcare team if you have:
- Severe kidney or liver problems.
- A history of seizures (fits) or brain injuries.
- Had a stroke in the past year.
- Are taking blood thinners like warfarin.
Discuss all other medications you’re taking, as Apalutamide can interact with various drugs.
What if Apalutamide isn’t suitable for me?
If Apalutamide isn’t suitable, other treatment options include:
- Different hormone therapies.
- Chemotherapy.
- Clinical trials.
- Radiotherapy in combination with other treatments.
Will taking Apalutamide affect my treatment options later on?
Yes, if you take Apalutamide and it stops working, you may not be able to use other hormone therapies like Abiraterone, Enzalutamide, or Darolutamide effectively. Your healthcare team will discuss the pros and cons of each treatment option with you.
How do I take Apalutamide?
Apalutamide is usually taken as four tablets once a day, with or without food. If you were already on another type of hormone therapy, you will continue it alongside Apalutamide. Most men will also receive an additional hormone therapy injection at their GP surgery, either once a month, every three months, or every six months, to keep testosterone levels low.
How long will my treatment last?
You will continue taking Apalutamide until it stops working or you experience severe side effects. Regular PSA blood tests will monitor its effectiveness.
What are the common side effects of Apalutamide?
Common side effects include:
- Extreme tiredness (fatigue)
- Skin rash
- High blood pressure (hypertension)
- Hot flushes
- Pain in bones and joints
- Diarrhoea
- Falls and fractures
- Loss of appetite and weight loss
What are the less common side effects?
There is a small risk of seizures (fits). If you have a history of seizures, discuss this with your healthcare team.
Should I use contraception while on Apalutamide?
Yes, if your partner is pregnant or could become pregnant, use a condom and another form of contraception while taking Apalutamide and for three months after. This prevents any potential harm to the baby.
How will my treatment with Apalutamide be monitored?
You will have regular hospital appointments to check how well the treatment is working. This usually involves:
- Blood tests for kidney or liver function
- Blood pressure checks
What if my PSA level rises while on Apalutamide?
If your PSA level rises, additional scans (MRI, bone scan, or CT) may be performed to check if the cancer has spread. Your healthcare team may suggest continuing Apalutamide or exploring other treatment options.
