@klein505 The phase III TITAN trial in 2018 demonstrated Apalutamide's effectiveness with ADT (doublet therapy) for treating mCSPC, and is the basis of its regulatory approval for that in the U.S., Canada, and elsewhere.

The ARANOTE trial, which concluded in late 2024, demonstrated the same thing for Darolutamide, but might be too recent to have made it through regulatory approval yet.

On the bright side, no trial has demonstrated that Apalutamide has any more side-effects than Darolutamide — the difference is purely theoretical and anecdotal at this point.

One retrospective study suggested that Apalutamide actually has *fewer* side-effects than Darolutamide, but it's even less reliable than most retrospective studies, so I wouldn't read too much into that.