Erleada

Unlike older hormone therapies, Erleada is a next-generation androgen receptor inhibitor that works differently from traditional androgen deprivation therapy (ADT). It’s taken orally as a 60mg tablet once daily, with or without food, making it convenient compared to injectable hormone treatments. The medication is typically used alongside ADT (hormone therapy that lowers testosterone) for mHSPC, or as monotherapy for nmCRPC in men who’ve had surgical or medical castration.

How Erleada Blocks Cancer Growth: Prostate cancer cells need androgens (male hormones) to grow and multiply. Even when testosterone levels are lowered through ADT or surgery, prostate cancer can sometimes find ways to keep growing by becoming more sensitive to remaining androgens or making its own hormones. Erleada works by directly blocking androgen receptors on cancer cells, preventing any androgens from attaching and signaling the cells to grow. This dual approach—lowering testosterone through ADT while blocking receptors with Erleada—creates a more complete hormone blockade that’s harder for cancer to overcome.

The medication prevents androgens from entering cancer cell nuclei, stops them from binding to DNA, and blocks the recruitment of proteins needed for cancer cell multiplication. Clinical trials showed Erleada significantly improved metastasis-free survival in nmCRPC patients and overall survival in mHSPC patients when combined with ADT, most patients starting treatment saw benefits within the first few months that were maintained long-term.

FDA-Approved Indications: Erleada treats metastatic hormone-sensitive prostate cancer (mHSPC) in combination with ADT for men whose cancer has spread but still responds to hormone therapy, and non-metastatic castration-resistant prostate cancer (nmCRPC) for men whose cancer hasn’t spread on imaging but continues growing despite castrate testosterone levels (below 50 ng/dL). For nmCRPC, the medication helps delay the time until cancer spreads to other parts of the body or bones.

Erleada is only for adult men and should never be used by women, especially those who are pregnant or may become pregnant, as it can cause miscarriage and severe birth defects. Men with female partners of childbearing age must use effective contraception during treatment and for 3 months after the last dose. The medication may also impair male fertility, men should not donate sperm during treatment or for 3 months afterward.

Treatment Monitoring: Before starting Erleada, your doctor will assess your cardiovascular health since the medication can increase risks of heart problems and stroke. You’ll need regular monitoring for blood pressure, cholesterol, blood sugar, and thyroid function throughout treatment. Blood tests track your PSA (prostate-specific antigen) levels to measure how well the cancer responds to treatment. For patients managing multiple conditions requiring medications from heart health medications categories, Erleada can often be continued with careful monitoring, though dose adjustments may be needed since it interacts with many common drugs including statins, blood thinners, and blood pressure medications.

Your doctor will also assess fall and fracture risks, particularly if you’re older or have bone problems like osteoporosis. Erleada can weaken bones and muscles, increasing both fall and fracture risks during treatment. Some doctors recommend calcium and vitamin D supplementation or bone-strengthening medications. The treatment requires ongoing coordination with your oncologist and other specialists, similar to patients using Casodex or other hormone therapies for prostate cancer.

If you experience seizures during treatment, Erleada must be stopped permanently. You should avoid activities where sudden loss of consciousness could cause serious harm to yourself or others, like driving or operating heavy machinery, until your doctor confirms seizure risk is managed. Most patients tolerate the medication well enough to continue treatment long-term, with side effects often improving after the first few months as your body adjusts.