@jeffmarc I'm on Apalutamide and have no side effects beyond the normal ones from my ADT. That's the challenge with anecdotal evidence: the people you're hearing from aren't randomly selected.

The clinical claim for Darolutamide is that it has fewer cognitive side effects because of the blood-brain barrier thing, but that doesn't eliminate the risk of other types of side-effects (cardio, digestive, liver, etc).

Fortunately, severe side-effects are relatively uncommon with all the -lutamides, so most of us are dealing mainly with the ADT ones.

Darolutamide + ADT doesn't seem to increase the risk of brain fog v.s. ADT alone, while Apalutamide may raise the risk by a couple of percentage points, but brain fog from ADT still overshadows any from the ARSI. That's why there are studies underway to see if we can do without ADT and continue on just the ARSI.