I don't remember your exact situation, @hanscasteels , but as I understand it, if the tumour is still contained fully in your prostate (non-metastatic) and responds to ADT (castrate-sensitive) — aka "nmCSPC" — then I think it wouldn't be normal to prescribe a lutamide or other ARSI in addition to the ADT, but that might have changed recently.
Apalutamide is approved in Canada for two situations:
1. non-metastatic castrate-resistant prostate cancer (nmCRPC), where the cancer hasn't metastasised yet but has stopped responding to ADT.
2. metastatic prostate-sensitive prostate cancer (mCSPC), where the cancer has metastasised, but is still responding to ADT.
In the TITAN trial, I think they continued Apalutamide after progression from mCSPC to mCRPC (metastatic castrate-resistant prostate cancer) and that it still showed benefits, but it's not recommended to start on it if you already have mCRPC — there are other lutamides approved for that.
Three different scan don’t show metastasis, but that doesn’t mean it isn’t lurking somewhere. I am starting on Firmagon this week (it only took three weeks to get this going for heaven’s sake). Next is figuring out when to start considering alternatives or complementary services. Given the track record of the “professionals” here… might be an interesting conversation of me trying to convince those that think they own the universe (at least they behave that way)