Apalutamide: Emerging Therapy for Non-Metastatic Castration-Resistant Prostate Cancer

Prostate cancer is the second deadliest cancer in the US and the fourth most common cancer among Saudi males. Patients usually present with non-metastatic disease and treated with localized therapy. However, up to 40% of the patients will experience biochemical recurrence, within 10 years. Androgen deprivation therapy (ADT) is used in this setting to delay metastatic disease. Patients with high prostate-specific antigen (PSA), despite appropriate ADT, are diagnosed with castrate-resistant prostate cancer (CRPC). A subset of those patients will be presented with a shorter PSA doubling time (PSA-DT) ≤10 months. These patients are identified at higher risk for metastatic disease and death from prostate cancer, which represents a challenging dilemma where optimal management is unclear. Apalutamide was the first drug to get approved in the localized setting to delay metastatic disease from occurring. This review article will discuss the development, safety, and efficacy of apalutamide and its current place in therapy

Clinical Pharmacy Faculty Provision of Direct Patient Care, Challenges, and Opportunities

BackgroundThe quadripartite mission of clinical track faculty members involves research, teaching, services, and direct patient care. However, the extent of faculty involvement in direct patient care remains a challenge. Thus, the study’s objective is to evaluate the effort spent on direct patient care by clinical faculty of pharmacy schools in Saudi Arabia (S.A.) and identify factors that hinder or facilitate providing direct patient care services.MethodsThis multi-institutional, cross-sectional questionnaire study conducted between July 2021 and March 2022 involved several pharmacy schools’ clinical pharmacy faculty members in S.A. The primary outcome was the percentage of time/effort spent on patient care services and other academic responsibilities. The secondary outcomes were the factors affecting the effort spent on direct patient care and the barriers preventing the provision of clinical services.ResultsA total of 44 faculty members took the survey. The percentage of effort spent on clinical education was highest at a median (IQR) of 37.5 (30, 50), followed by that spent on patient care [19 (10, 28.75)]. The percentages of effort spent on education and the length of academic experience were negatively associated with efforts spent on direct patient care. The most commonly reported barrier affecting fulfilling patient care duties was the lack of a clear practice policy (68%).ConclusionAlthough most clinical pharmacy faculty members were involved in direct patient care, half of them devoted only 20% or less of their time to it. An effective effort allocation for clinical faculty duties will require the development of a clinical faculty workload model that sets realistic expectations about the time spent on clinical and non-clinical duties