Table 2.

Expert panel recommendations for clinical assessment and management of patients receiving apalutamide in combination with ADT

	Clinical assessment/tests	Notes
Before initiating treatment	Clinical history—review for cardiovascular events and concomitant medications Assessment of comorbidities/patient frailty Assess fracture/fall risk Consider baseline thyroid function test	If patient has a history of cardiovascular disease or cardiovascular events in past 6 months, refer to cardiologist before starting treatment Patients with a history of osteopenia/previous fractures/frailty need careful management (physiotherapy, vitamin D and/or calcium/antiresorptive agents) due to potential impact of apalutamide plus ADT on BMD
Each clinic visit (monthly initially, then every 3 months)	Check PSA level Assessment of liver, kidney, and thyroid function Review of any patient-reported side effects (fatigue, skin rash)
Every 6 months	CT imaging and bone scan OR PSMA-PET

ADT antigen deprivation therapy, BMD bone mineral density, CT computed tomography, PSA prostate-specific antigen, PSMA-PET prostate-specific membrane antigen-positron emission tomography