Apalutamide vs abiraterone: which is more effective?

I was on apalutmide (Erleada ) and ADT for a year. The side effects, flashes, tired, poor sleep, were noticeable but manageable It is a more recently developed drug than other inhibitors so I would and probably will do Erleada and ADT again. I have battled this
G 9, CRPC for 3 years and so far doing ok.

I've been on Erleada and ADT for over 2½ years. It's hard to be sure, but I think most of the nastiest side-effects come from the ADT, not the Erleada, because they'd flare up every month when I got my Firmagon injection and then settle down for a few weeks until the next one (I've recently switched to Orgovyx, so that's no longer an issue). Otherwise, it's just the normal loss-of-testosterone symptoms, that I'd have on ADT with or without adding an ARSI like Apalutamide.

Because my cancer caused a spinal injury, I was on Prednisone (a steroid) as well post-surgery for a few weeks to try to bring down the inflammation that had compressed my spine, and that WAS a bad thing (far worse than ADT or Apalutamide). Among other things, it induced diabetes (blood sugar as high as 17 sometimes), so I had to go on insulin and get my finger pricked several times/day at the hospital until they decided it wasn't helping my recovery and stopped it, at which point the diabetes stopped quickly as well.

I'm on firmagon monthly, was monthly on Xgeva but starting next month, it will be quarterly. Take Abiraterone and prednisone daily. Sometimes I could pull my hair out trying to figure out what med is giving me what side effect. Right now, I'm hoping the Xgeva is causing the shortness of breath and by going quarterly it will ease up, can only hope, but at the end of the day I can do shortness of breath rather then the pain I had before starting treatment. best to all

I just wanted to add, been reading side effects of the different treatments, my goodness the list is almost endless. Hopefully we don't end up with all of them but if in the end they do their job, is okay by me. I never want to loose site of why I'm taking them in the first place, as my Oncologist said, to control it.

FYI - been on Arbiterone - Prednisone 18 months- no shortness of breath noted, not even on the treadmill for 1.2 miles,

I suspect a lot of it has to do with your age, fitness level, and general health going in.

In some ways, I feel healthier and more energetic now (after 2 rounds of radiation and 31 months on ADT and ARSI) than I did before my cancer diagnosis; in other ways, not so much.

But the side-effects of cancer treatments haven't been life-shattering for me (in my 50s) the way some people have reported in this forum; the spinal-cord compression had a far bigger impact on my life.

My husband has been taking abiraterone and prednisone since January 2020 and has had Lupron shots for many years before that and continues with them. His side effects of fatigue and hot flashes result from the Lupron in our opinion, not from the abiraterone.

Yes, the hot flushes are a real challenge, and I agree that they're mostly likely from the ADT (like Lupron, Firmagon, or Orgovyx), not from the ARSI.

My hot flushes seem to have faded a bit since 2021, but they still happen, and it's embarrassing to be sitting in public suddenly dripping sweat and hoping no one thinks you're having a heart attack.

If you haven’t, get checked for blood clots. I didn’t know cancer causes blood to clot much easier and came pretty close to “the end” because I had a saddle pulmonary embolism and DVT in my left leg. Had shortness of breath and eventually couldn’t breathe lying down. Couple of days in the hospital and several bags of heparin later and I was on the road to recovery. On eliquis now, cardiologist said it will be 3-6 months to fully recover… This was before I even started the cancer treatment, fun stuff!

Thanks for posting that.

I learned about cancer and blood clots the hard way. I had been immobilised in a hospital bed for a few weeks when the thrombologists (fortunately) stopped by. They detected DVT in my left calf (which I could barely even feel at the time, much less move).

They told me exactly the same thing you posted, that blood clots are more common in cancer patients (though lack of mobility also contributed in my case). I'm on a low dose of blood thinners permanently, alongside my other medications, and have annual check-ins with my thrombosis team