Changes to the Prescribing of Enzalutamide (Xtandi) for Prostate Cancer

As of January, there will be changes to the prescribing of Enzalutamide (Xtandi®) for prostate cancer.

Urologists will need to sign up to the access weblink provided by Astellas in preparation for prescribing under the new changes, making the drug more widely available. Similar to when we start patients on androgen deprivation therapy, we do not need to send men with metastatic hormone-sensitive prostate cancer (mHSPC) to Medical Oncologists to initiate treatment. It is both easy and reasonable to initiate Enzalutamide at diagnosis and when used with a standard LHRH agonist will not need Bicalutamide to cover a possible flare. The EMBARK study also reports in February and we look forward to further news on Enzalutamide. We expect other novel androgen inhibitors such as apalutamide to also follow suit in treating men with mHSPC.

Urologists should remain primarily responsible for the management of patients with prostate cancer, bearing in mind the standard of care includes multidisciplinary team involvement.

Access to this scheme is now available, please consider adding this protocol to your armamentarium as per the excerpt below;

access to Xtandi for men with mHSPC meeting the below criteria will be available FREE OF CHARGE via the Astellas Assist Program. 

You will need to sign up and enroll patients to the web-based program online via, which will also provide you with updates to the program.

The Astellas Assist Program will have two access options for Xtandi:

1. Full subsidy scheme (provision of free medication)
XTANDI is supplied free for people who:

1.    have metastatic hormone-sensitive prostate cancer (mHSPC)
2.    hold a current Medicare card
3.    are receiving treatment with androgen deprivation therapy (ADT) which is/has been initiated within 6 months of treatment initiation for their mHSPC
4.    have not received treatment with another novel hormone therapy (NHT) listed on the PBS
5.    are expected to receive benefit from treatment

2. Partial Subsidy Scheme (buy 1, get 1 box of medication for free)
XTANDI is partially subsidised when:

1.    treatment is for an approved indication in Australia
2.    for people who meet one of the following criteria:
       - Australian aged pensioner (65+)
       - Commonwealth seniors’ health care card
       - Low-income health card
       - New starter allowance (unemployed)
       - Experiencing significant financial distress
1.    are expected to receive benefit from treatment.”

The prostate cancer paradigm will continue to evolve and integrate these novel androgen inhibitors. USANZ is not seeking to alter prescribing preferences in sharing this information. Our goal is to improve patient access to appropriate medication.

To ensure that our Members are up-to-date with these changes in practice, the USANZ 2023 ASM in February will have a relevant workshop entitled "A new era for urologists in mHSPC”. 

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