This clinical trial is focused on studying a type of prostate cancer known as metastatic castration-resistant prostate cancer (mCRPC). This is a form of prostate cancer that continues to grow and spread even when the amount of male hormones in the body is reduced to very low levels. The study is investigating the effectiveness and safety of a treatment combination that includes the medication JNJ-56021927, also known as apalutamide, in combination with abiraterone acetate and prednisone. These medications are being compared to the use of abiraterone acetate and prednisone alone.
The purpose of the study is to see how well the combination of these medications works in slowing down the progression of the cancer when compared to the standard treatment. Participants in the study will be randomly assigned to receive either the combination treatment or the standard treatment. The study will be conducted in a way that neither the participants nor the researchers will know which treatment each participant is receiving, which is known as a double-blind study. Some participants may receive a placebo instead of the active medication to help compare the effects.
Throughout the study, participants will take the medications in the form of tablets by mouth. The study will last for a period of up to 48 months, during which time participants will have regular check-ups and tests to monitor their health and the progression of the cancer. The main goal is to determine how long the cancer can be controlled without it getting worse, which is referred to as radiographic progression-free survival. Other aspects being studied include overall survival, the time until the need for pain medication, and the time until chemotherapy might be needed.



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