Xtandi vs Zytiga: A Patient’s Comparison Guide

If you or a loved one has been diagnosed with advanced prostate cancer, your oncologist may have presented two oral medication options: Xtandi (enzalutamide) and Zytiga (abiraterone acetate). Both are FDA-approved for treating advanced prostate cancer, but they work very differently and have distinct side effect profiles, dosing requirements, and cost considerations.

This guide compares Xtandi and Zytiga side by side to help you have a more informed conversation with your healthcare team about which medication may be right for your situation.

How Xtandi and Zytiga Work

Both medications target the role of androgens (male hormones, primarily testosterone) in fueling prostate cancer growth — but they attack the problem from opposite directions.

Xtandi (Enzalutamide) — Androgen Receptor Inhibitor

Xtandi works by blocking the androgen receptor itself on prostate cancer cells. Even if androgens are present in the body, Xtandi prevents them from binding to and activating the receptor — which means the cancer cells can’t receive the “grow” signal.

According to the National Cancer Institute, Xtandi is approved for:

• Metastatic castration-resistant prostate cancer (mCRPC)
• Non-metastatic castration-resistant prostate cancer (nmCRPC)
• Metastatic castration-sensitive prostate cancer (mCSPC)

Zytiga (Abiraterone Acetate) — Androgen Production Inhibitor

Zytiga works by blocking the production of androgens. It inhibits an enzyme called CYP17, which is required to make testosterone in the testes, adrenal glands, and even within prostate tumors themselves. By cutting off the androgen supply, Zytiga starves prostate cancer cells of the hormones they need to grow.

Zytiga is approved for:

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

For a complete overview of how Zytiga works, see our comprehensive Guide to Abiraterone.

How Each Medication Is Taken

This is one of the most practical day-to-day differences for patients.

Xtandi Administration

• Form: Oral capsules or tablets (40 mg, 80 mg)
• Standard dose: 160 mg (typically 4 capsules or 2 tablets) once daily
• Food: Can be taken with or without food
• Steroids required: No — Xtandi does not require co-administration of prednisone

Zytiga Administration

• Form: Oral tablets (250 mg or 500 mg)
• Standard dose: 1,000 mg once daily
• Food: Must be taken on an empty stomach — at least 2 hours after eating and 1 hour before next meal. Taking with food significantly increases absorption and side effect risk.
• Steroids required: Yes — Zytiga must be taken with prednisone or methylprednisolone to prevent serious side effects related to cortisol suppression

Have Questions About Either Medication?

Call (917) 830-2525

Side Effect Comparison

Both medications can cause significant side effects. The profiles differ, which is one of the main factors oncologists consider when choosing between them.

Common Xtandi Side Effects

• Fatigue (often more pronounced than with Zytiga)
• Hot flashes
• High blood pressure (hypertension)
• Headache
• Joint pain
• Decreased appetite
• Falls and fractures (Xtandi can affect balance)
• Seizure risk — rare but serious; Xtandi may not be appropriate for patients with a history of seizures or brain conditions
• Cognitive changes (memory issues, difficulty concentrating)

Common Zytiga Side Effects

• Fatigue
• Joint swelling and discomfort
• Hot flashes
• High blood pressure (hypertension)
• Low potassium (hypokalemia) — requires regular blood monitoring
• Fluid retention and swelling (edema)
• Liver enzyme elevations — requires regular blood monitoring
• Diarrhea or nausea
• Adrenal insufficiency — managed by co-prescribed prednisone

For a complete breakdown of Zytiga side effects and how to manage them, see our detailed Zytiga side effects patient guide.

Effectiveness: How Do They Compare?

Both Xtandi and Zytiga have been shown in clinical trials to extend overall survival and delay disease progression in men with advanced prostate cancer compared to placebo or standard care alone.

There have been some head-to-head comparison studies, but the medical consensus is that both are highly effective and the better choice depends on individual patient factors rather than a clear-cut “winner.” Most oncologists choose between them based on:

• Cancer stage and biology
• Presence of other medical conditions (seizures, hypertension, diabetes, liver issues)
• Patient’s other medications and potential drug interactions
• Patient’s ability to tolerate prednisone (required for Zytiga)
• Patient’s lifestyle and ability to follow strict food timing (Zytiga requires empty stomach)
• Cost and insurance coverage considerations

Cost and Generic Availability

This is where the two medications differ significantly.

Xtandi Cost

Xtandi (enzalutamide) does not have a generic version available in the United States as of May 2026. Brand-only pricing means out-of-pocket costs can be substantial without insurance or copay assistance. According to Drugs.com, retail pricing for brand Xtandi typically exceeds $13,000 per month for the standard 160 mg daily dose, depending on pharmacy and location.

Zytiga Cost

Zytiga has had FDA-approved generic versions available since October 2018, which has dramatically reduced costs for many patients. Multiple manufacturers (including Hikma, Mylan, MSN, and others) produce generic abiraterone acetate, and most insurance plans now require generic substitution. According to Drugs.com and GoodRx, generic abiraterone retail pricing starts well below brand Zytiga pricing.

For more on generic abiraterone availability and manufacturers, see our guide on whether there’s a generic for Zytiga.

Xtandi vs Zytiga Side-by-Side

How QuickRx Helps Patients on Either Medication

QuickRx Specialty Pharmacy supports prostate cancer patients on both Xtandi and Zytiga (and generic abiraterone) with:

• Free copay assistance consultation for both medications
• Insurance benefits verification and prior authorization support
• Coordination with your oncology team
• Nationwide 2-day delivery (licensed in all 50 states)
• Refill management and renewal reminders
• Dedicated patient navigators who handle paperwork on your behalf

For copay assistance with abiraterone (Zytiga), visit our abiraterone copay assistance page. For Xtandi or general questions, call (917) 830-2525.

Related Reading

• Want a complete overview of how abiraterone (Zytiga) works? Read our comprehensive Guide to Abiraterone.
• Worried about Zytiga side effects? See our detailed Zytiga side effects patient guide.
• Wondering if there’s a generic version of Zytiga? Read about generic abiraterone availability.
• Have specific patient questions? See our abiraterone FAQ.

References

1. National Cancer Institute. Enzalutamide Drug Information. Available at cancer.gov.
2. National Cancer Institute. Abiraterone Acetate Drug Information. Available at cancer.gov.
3. U.S. Food and Drug Administration. Xtandi (enzalutamide) Prescribing Information. Available at fda.gov.
4. U.S. Food and Drug Administration. Zytiga (abiraterone acetate) Prescribing Information. Available at fda.gov.
5. Drugs.com. Xtandi and Zytiga pricing information. Available at drugs.com.