When You Can't Get Abiraterone: Know Your Options

If you've been prescribed Abiraterone for prostate cancer and can't fill your prescription — whether due to stock issues, cost, or insurance problems — it's natural to feel anxious. Cancer treatment shouldn't be delayed. The good news is that there are several proven alternative medications that your oncologist may consider.

Important: Never switch or stop cancer medications on your own. Always talk to your oncologist before making any changes to your treatment plan. This article is meant to help you have an informed conversation with your doctor.

What Is Abiraterone and How Does It Work?

Abiraterone Acetate (brand names Zytiga and Yonsa) belongs to a class of drugs called CYP17 inhibitors. It works by blocking the CYP17 enzyme, which your body uses to produce testosterone and other androgens. Since many prostate cancers depend on these hormones to grow, Abiraterone essentially starves the cancer cells of their fuel.

Abiraterone is FDA-approved for:

• Metastatic castration-resistant prostate cancer (mCRPC)
• Metastatic high-risk castration-sensitive prostate cancer (mCSPC)

It's taken as a 1,000 mg daily oral dose with Prednisone. For a complete overview, see our article on what Abiraterone is and how to take it. To understand the science behind it, read how Abiraterone works.

Alternative #1: Enzalutamide (Xtandi)

Enzalutamide is one of the most commonly used alternatives to Abiraterone. It's an androgen receptor inhibitor — rather than blocking testosterone production like Abiraterone does, Enzalutamide blocks the androgen receptor itself, preventing testosterone from signaling cancer cells to grow.

Key facts about Enzalutamide:

• Dose: 160 mg taken orally once daily
• Approved for: mCRPC, mCSPC, and non-metastatic CRPC (nmCRPC)
• Does not require Prednisone — unlike Abiraterone
• Can be taken with or without food
• Common side effects: Fatigue, hot flashes, diarrhea, high blood pressure, and rarely seizures
• Cost: Typically $10,000–$15,000 per month without insurance; copay programs are available

Research comparing Enzalutamide and Abiraterone in metastatic hormone-sensitive prostate cancer shows comparable outcomes in terms of overall survival and time to castration resistance. Your oncologist can help determine which is better suited to your specific situation.

Alternative #2: Apalutamide (Erleada)

Apalutamide is another androgen receptor inhibitor with FDA approval for prostate cancer. It's particularly notable for its approval in non-metastatic castration-resistant prostate cancer — a setting where it can delay the spread of cancer.

Key facts about Apalutamide:

• Dose: 240 mg taken orally once daily
• Approved for: Non-metastatic CRPC (nmCRPC) and mCSPC
• Does not require Prednisone
• Common side effects: Fatigue, high blood pressure, rash, diarrhea, nausea, joint pain, hot flashes, and falls/fractures
• Cost: Similar to Enzalutamide; copay assistance programs are available from the manufacturer

Alternative #3: Darolutamide (Nubeqa)

Darolutamide is a newer androgen receptor inhibitor that has gained attention for its lower rate of central nervous system side effects compared to Enzalutamide and Apalutamide. This can be an important consideration for patients concerned about fatigue, cognitive changes, or seizure risk.

Key facts about Darolutamide:

• Dose: 600 mg taken orally twice daily (with food)
• Approved for: Non-metastatic CRPC (nmCRPC) and metastatic hormone-sensitive prostate cancer (mHSPC) in combination with Docetaxel
• Does not require Prednisone
• Common side effects: Fatigue, pain in extremities, rash
• Notable advantage: Lower blood-brain barrier penetration means fewer neurological side effects

Alternative #4: Docetaxel (Chemotherapy)

Docetaxel is a chemotherapy drug that works through a completely different mechanism than Abiraterone or the androgen receptor inhibitors. Instead of targeting the hormonal pathway, Docetaxel disrupts cancer cell division directly.

Key facts about Docetaxel:

• Administration: Intravenous (IV) infusion every 3 weeks, usually for 6 cycles
• Approved for: mCRPC and mCSPC
• Common side effects: Hair loss, fatigue, nausea, low blood counts, neuropathy (tingling/numbness in hands and feet)
• Different approach: May be recommended if hormonal therapies are no longer effective or appropriate

Docetaxel is sometimes used in combination with hormone therapies, including Darolutamide. Your oncologist will consider your overall health, cancer stage, and previous treatments when deciding if chemotherapy is appropriate.

How to Decide Which Alternative Is Right for You

Choosing between these medications is a decision you should make with your oncologist. Factors they'll consider include:

• Your cancer stage and type — mCRPC, mCSPC, or nmCRPC
• Previous treatments — what you've already tried and how well it worked
• Side effect profile — some drugs are better tolerated than others
• Other medications you take — drug interactions vary between treatments
• Cost and insurance coverage — coverage varies significantly between drugs
• Convenience — oral vs. IV, once daily vs. twice daily, food requirements

Before Switching: Try to Find Abiraterone First

If you're considering alternatives because you simply can't find Abiraterone at your pharmacy, try these steps first:

• Use Medfinder to search for pharmacies with Abiraterone in stock near you
• Ask about specialty pharmacies that regularly stock oncology medications
• Look into copay assistance programs if cost is the issue
• Read our guide on how to find Abiraterone in stock near you

Final Thoughts

If Abiraterone isn't accessible for you right now, know that you have options. Enzalutamide, Apalutamide, Darolutamide, and Docetaxel are all proven treatments for prostate cancer with strong clinical evidence behind them. The key is working closely with your oncologist to find the right fit for your situation.

Don't delay your treatment. Whether you find Abiraterone through Medfinder or explore an alternative with your doctor, what matters most is that you stay on track with your cancer care.