Like all the -lutamides, Apalutamide can be very effective — so much so that they had to unblind the TITAN trial because it was unethical to keep half the participants on placebo. That study didn't reach median overall in its 4½ years, even (IIRC) counting those who had started on placebo and then switched and those who had become castrate-resistant during the trial, because the participants just kept living so darned long. 🙂

Erleada (Apalutamide's brand name) is in the Ontario formulary, so your ODB should cover it without having to mess with the extra paperwork around joining a patient-access programme or getting authorisation from private insurance (which is important, since it would cost nearly CA $5,000/month otherwise).