Apalutamide in Metastatic Castration-Sensitive Prostate Cancer (mCSPC): A Case-Based Discussion
Release Date: 05/31/2024
AUANews Inside Tract
Developed by the Society of Academic Urologists in partnership with the American Urological Association, the SAU/AUA Urology Match Insider series provides medical students interested in the field of urology an inside look into the Urology Residency Match process. In this episode, medical student Avani Desai, sits down with Dr. Kathleen Kieran and Dr. Costas Lallas to discuss putting together your match application, including crafting your personal statement, securing letters of recommendation and how to make yourself stand out. The Urology Residency Match (Urology Match or SAU Match) is...
info_outlineAUANews Inside Tract
In this episode of AUA Inside Tract, join Dr. Hans Arora, a practicing pediatric urologist at the UNC School of Medicine, as he talks with Dr. Stephen Nakada, the AUA’s immediate past president, about his presidency and what he took away from his year in the position.
info_outlineAUANews Inside Tract
The standard treatment for muscle-invasive urothelial carcinoma (MIUC) has been radical surgery combined with cisplatin-based chemotherapy for eligible patients. However, over 50% of patients face metastatic progression after surgery. This non-CME webinar, presented by a urology expert, will discuss how patients with UC at high risk of recurrence after radical resection may benefit from adjuvant immunotherapy, emphasize the role of multidisciplinary communication in patient care, and review a subcutaneous immunotherapy option for the adjuvant treatment of UC.
info_outlineAUANews Inside Tract
Developed by the Medical Student Membership Workgroup, the Urology Spotlight Series educates medical students about a particular subspecialty within urology, including common cases and procedures. In this episode, Nana Frimpong, medical student at Drexel University College of Medicine, is joined by Dr. Jessica Mandeville, Assistant Professor of Urology at Tufts University and Director of Endourology at Lahey Hospital Medical Center, for a discussion on the field of Endourology.
info_outlineAUANews Inside Tract
In this episode of AUA Inside Tract, join fellow Dr. Andrew Lai and newly minted attending Dr. Rabun Jones as they reflect on life after residency, tackling imposter syndrome and the challenges of stepping into new roles. They also share personal perspectives on LGBTQ+ representation and the evolving culture of acceptance in medicine.
info_outlineAUANews Inside Tract
Developed by the Society of Academic Urologists in partnership with the American Urological Association, the SAU/AUA Urology Match Insider series provides medical students interested in the field of urology an inside look into the Urology Residency Match process. In part 1 of this episode, medical student, Vivian Wang, sits down with Dr. Gina Badalato and Dr. Erica Traxel to discuss what students need to know about the Match, including timeline, dos and don’ts for applicants and what to expect during the process. The Urology Residency Match (Urology Match or SAU Match) is governed by the...
info_outlineAUANews Inside Tract
In this episode of AUA Inside Tract, join Dr. Petar Bajic, director of Men's Health, and Dr. Raevti Bole, Men's Health specialist, from the Cleveland Clinic as they share clinical insights and real-world perspectives on men’s health. From prevention to patient care, this episode highlights what clinicians need to know during Men’s Health Month.
info_outlineAUANews Inside Tract
The Physician Scientist - Different Paths to Success Webinar was held on May 20, 2025. This webinar highlighted the diverse experiences of our panelists and showcased the multiple career trajectories available to physician-scientists in urology.
info_outlineAUANews Inside Tract
Developed by the Medical Student Membership Workgroup, the Urology Spotlight Series educates medical students about a particular subspecialty within urology, including common cases and procedures. In this episode, Daniela Orozco-Rendon, medical student at Geisel School of Medicine at Dartmouth, is joined by Dr. Mohit Khera, Professor of Urology and F. Brantley Scott Chair in Urology at Baylor College of Medicine, for a discussion on the field of Andrology/Men’s Health.
info_outlineAUANews Inside Tract
In this episode, Dr. Amanda North, Chief of Pediatric Urology at Children's Hospital at Montefiore Einstein, joins Dr. Susan MacDonald, Program Director at Penn State, for a deep dive into fellowship training trends in urology. Using AUA census data, they explore generational shifts, gender disparities and evolving motivations for pursuing fellowships. From the growing percentage of women in the field to the increasing complexity of urologic care, they discuss how patient expectations, academic aspirations and practice models are reshaping the specialty. The 2025 AUA Census is now open. Visit...
info_outlineThis podcast “Apalutamide in Metastatic Castration-Sensitive Prostate Cancer (mCSPC): A Case-Based Discussion” was originally presented as an AUA newsworthy webinar and contains data regarding the clinical efficacy and safety of apalutamide. It is presented on behalf of Janssen and is not certified for CME; speakers were compensated. For full details, see the video webinar here.
TITAN, a Phase 3 double-blind study, randomized patients with metastatic castration-sensitive prostate cancer (mCSPC) to apalutamide (Apa; 240 mg oral once daily) + androgen deprivation therapy (ADT; n=525) or placebo + ADT (n=527).1,2 All patients received a concomitant gonadotropin-releasing hormone analog or had prior bilateral orchiectomy.3 Patients who received prior treatment for localized disease or received but did not progress on docetaxel were permitted. Dual primary endpoints were radiographic progression-free survival and overall survival (OS).1,2
At primary analysis (median follow-up: 22.7 months), Apa + ADT reduced the risk of radiographic progression or death by 52% vs placebo + ADT (HR: 0.48; 95% CI: 0.39–0.60). Apa + ADT also reduced the risk of death by 33% vs placebo + ADT (HR: 0.67; 95% CI: 0.51–0.89).1 At primary analysis cutoff, TITAN was unblinded and 39.5% of patients who received placebo + ADT crossed over to receive Apa + ADT; these patients were analyzed as part of the placebo + ADT population in the intent-to-treat analyses. The IPCW log-rank test was performed to account for crossover and showed a 48% reduction in the risk of death for Apa + ADT vs placebo + ADT (HR: 0.52; 95% CI: 0.42–0.64). At final analysis (median follow-up: 44.0 months), Apa + ADT reduced the risk of death by 35% vs placebo + ADT (median OS: NE vs 52.2 months; HR: 0.65; 95% CI: 0.53–0.79).
In a prespecified subgroup analysis, Apa + ADT improved OS vs placebo + ADT, regardless of disease volume. In patients with high-volume disease, Apa + ADT reduced the risk of death by 30% vs placebo + ADT (HR: 0.70; 95% CI: 0.56–0.88); for low-volume disease, Apa + ADT reduced the risk of death by 48% vs placebo + ADT (HR: 0.52; 95% CI: 0.35–0.79).2
The following post hoc analyses data are not included in the full ERLEADA® (apalutamide) Prescribing Information.
Post hoc exploratory analyses investigated PSA kinetics.4,5 After 3 months of Apa treatment, median OS was not reached in patients with a PSA response. In patients without a PSA response, median OS was 37.7 months.5 Most Apa + ADT-treated patients had undetectable PSA at 3 months. By 12 months, 64% of Apa-treated patients had undetectable PSA vs 23% of patients treated with placebo + ADT.5
Please see the full Prescribing Information for ERLEADA® (apalutamide) at www.erleadahcp.com.
- Chi KN, et al. N Engl J Med. 2019;381:13–24.
- Chi KN, et al. J Clin Oncol. 2021;39:2294–2303.
- ERLEADA® (apalutamide) [Prescribing Information]. Horsham, PA: Janssen Biotech, Inc.
- Chowdhury S, et al. Ann Oncol. 2023;34:477–485.
- Chi KN, et al. Presented at AUA; September 10–13, 2021; Las Vegas, Nevada.