Darolutamide is the newest. Has the least side effects. You’ve already been on Enzalutamide so apalutamide is almost definitely not going to help. It works the same as Enzalutamide as does Darolutamide. You need to go another direction.

If you have not been on Zytiga then it may be the best bet for the next drug, but you have to speak to your oncologist to find that out. Zytiga is hard on the heart. Can raise your blood pressure. Causes hot flashes to become more intense. Makes the brain fog worse. But it can give more years of low PSA.

Another option is BAT where you have testosterone injections to try and reset the ability of Enzalutamide to work again. Doesn’t always work.

No, definitely go with what you and your cancer team decide on after careful evaluation. Overall survival alone is a tricky stat, because we all start from different places: is your cancer localised or metastatic? castrate-sensitive or castrate-resistant? oligo or high-load metastatic? bones, lymph nodes, and/or organs? how old are you? how's your heart? how well do you tolerate hormone therapy? how active are you? do you have diabetes or other comorbidities? what have you already tried? etc etc.

If the median OS is slightly higher for one treatment than for another, that doesn't mean that the same will apply to your specific situation.