Apalutamide vs abiraterone: which is more effective?

Thanks for all the above. Most helpful.
My last Lupron shot was 1/4/24.
Paroxetine 40mg has helped reduce the hot flashes intensity and frequency a bit. And glad of it.
Now, my fatigue has subsided about 50% but hot flashes continue about the same. I love the 4 fans with remote switches I have placed in the house where I usually sit or sleep (and sometimes I carry a little 'pocket' fan to events).
Question for "northoftheborder", am I correct that you ended Lupron in 2021 and your hot flashes continue???
My onco said they will subside slowly but it goes slower with age. I'm 77 now and even having them reduced as they are I'd be way more happy to be done with them!
Thank you all for your candid info!

I don't believe that there have been any randomized controlled trials for abiraterone vs apalutamide. I believe there was at least one retrospective study which showed a small benefit of apalutamide vs abiraterone. I was on ADT (lupron) for 2 years before starting abiraterone. I did not have any additional side effects from abiraterone.

Your decision doesn't need to be permanent. If the abi is creating side effects after starting it you can switch to another (enzalutamide, apalutamide, or darolutamide). My understanding is that darolutamide has the least side effects.

Another consideration is cost. Unlike the other ARPIs, abiraterone is now generic. You should be able to get it much cheaper than the others. You should check with your insurance provider to determine cost of abi vs apalutamide.

No. that's probably another poster. I was on Firmagon+Apalutamide from October 2021 (mCSPC), then switched to Orgovyx+Apalutamide a bit over a month ago. So far my PSA remains undetectable (< 0.01), down from 67 in 2021. I've also had debulking surgery to my spine and two rounds of radiation (spine and prostate).

I’ve been on Apalutamide for 3 years.I take Lupron injections every 4 months.Previously I was on Bicalutamide and Degaralix monthly injections.Apart from the usual side effects I now have osteoporosis.This past winter I had 3 compression fractures in my spine.Now I will be on Prolea to combat the osteoclastic activity.It’s not easy but better than the alternative.I manage to live with the side effects however unpleasant.There may be new treatment options coming but best to stay the course with what medical research will provide us with.I joke and say that if Musk or Bezos would have prostate cancer then maybe a cure would be available.In no way do I wish these men to have Prostate Cancer.This disease is not for sissies.

When Mr. Musk first came out with Space-X, it exploded on the launchpad. His new Cybertruck catches fire randomly and there's no easy way out from the back seat.

If he came out with a prostate-cancer treatment, I don't think I'd be first in line to volunteer for the trial. 😉

A very correct statement

I have been on Eligard (Lupron) for 4.5 weeks with no side effects. Why? Some combination of DNA, a plant-based diet and a rigorous exercise regime involving both muscle building, aerobics on an elliptical machine and power hiking in the hills of Eugene. I agree with @northoftheborder. I feel better than before PCa.

Tomorrow go on Erleada, hoping side effects remain undetectable.

Hi "starman", Sad to hear of your bad side effects. Keep up the fight against those as well.
Prolia is our friend and I'm glad my onco started my injections right along with the Lupron. Also, he told me to add oral calcium (OTC) to my vitamins as I already had some bone loss in my left femur. Maybe consider it for yourself as long as your doc's agree.
Best of luck and the most helpful results in your course of action against the PC and all the troubles in starts.

There are 2 forms of ADT. One surgical, one chemical.

READ ALL YOU CAN.

i chose the surgical option, Orchiectomy with reconstruction. 95% of testosterone production permanently achieved in 90 minutes. One less thing to manage...

Also doing abiraterone/prednisone, coupled with 6 docetaxel infusions 21 days apart.