Who Is Eligible for — Enzalutamide?

Prior abiraterone does not automatically rule out enzalutamide, but it is a significant factor in the prescribing decision. Both drugs target the androgen signalling pathway, so if the cancer has become resistant to one, it may have developed resistance mechanisms that reduce the benefit of the other. Your oncologist will weigh this against what else has been tried and what alternatives remain. It is a question worth asking directly: what does the evidence suggest for someone who has already had abiraterone?

It depends on the condition. Heart disease, diabetes, and high blood pressure do not automatically make you ineligible, though they are relevant to how you are monitored during treatment. Severe liver impairment does affect eligibility because enzalutamide is processed by the liver. A history of seizures is a significant consideration, and your neurologist may need to be involved in the decision. Your oncologist will weigh each condition individually — do not assume you are ruled out without having that conversation.

In most cases, yes. Enzalutamide works by blocking the androgen receptor, but the body can still produce some testosterone even during treatment. Continuing ADT keeps testosterone suppressed so that enzalutamide can work as intended. If you have had a surgical castration, ADT injections are generally not required. Your oncologist will confirm which applies to you — combining enzalutamide with ongoing ADT is standard practice across all three approved disease states.

Enzalutamide is approved by the CDSCO and is available in India. Any cost figure here would be dated within months, so ask your oncologist or the hospital pharmacy for the current cost at your prescribed dose and duration. It is also worth asking whether a government health scheme, insurance cover, or the manufacturer's patient-access programme applies to your situation — eligibility for these varies and is worth checking before paying out of pocket.

Standard bone scans and CT scans of the chest, abdomen, and pelvis are typically used to assess whether the cancer has spread. PET-CT with a PSMA tracer can detect spread earlier and at smaller volumes than conventional imaging, and your oncologist may arrange this if a standard scan is inconclusive. The imaging result, combined with your PSA trend and testosterone level, establishes your disease state. If imaging is equivocal, your oncologist may repeat it or use additional tests before making a decision.

The alternatives depend on which disease state you are in and what you have already had. Abiraterone is a closely related option approved across multiple stages of advanced prostate cancer. Darolutamide and apalutamide are other AR inhibitors approved for specific stages. If your tumour carries particular genetic features — such as a BRCA mutation — PARP inhibitors may be an option, and your oncologist may arrange genetic testing of your tumour tissue. Chemotherapy with docetaxel remains a standard option for castration-resistant disease. Being unsuitable for enzalutamide is not the same as being out of options.