Prostate cancer is the most common cancer and the second prominent cause of cancer-related deaths in men. As per the 2018 statistical data analysis, about 1,280,000 newly diagnosed cases of prostate cancer and 359,000 deaths were estimated around the globe. In India, about 25, 696 new cases and 17,184 deaths were estimated in 2018.
Besides higher prevalence rates, it is possible to win the battle against prostate cancer. For the past 70 years, radiation therapy, prostate biopsy, surgery, androgen deprivation therapy and non-hormonal chemotherapy agents such as docetaxel and cabazitaxel have been the standard of care for men with prostate cancer (in early stages), but these treatment options were not effective in advanced stages.
Recent advances in research and a better understanding of prostate cancer biology has led to the development of newer hormonal agents. These agents directly inhibit androgen production, a potential cause of prostate cancer progression. Among various hormonal agents, Abiraterone acetate (AA) has proved to be a boon for patients suffering from prostate cancer.
In this blog, we will discuss:
- Clinical use of Abiraterone acetate
- Mechanism of action
- Dosage and Administration
- Clinical efficacy
- Advantages of Abiraterone acetate
- Adverse events
- Warning and Precautions
Clinical use of Abiraterone acetate
Abiraterone acetate is an FDA approved prescription drug used to treat prostate cancer which is advanced and has spread to other parts of the body (metastatic). It is usually used in combination with prednisone either after docetaxel chemotherapy or following failure of other hormone treatments.
Mechanism of action
Abiraterone acetate belongs to the class of CYP17 inhibitors. It acts by interrupting the androgen synthesis process. It blocks androgen synthesis at three sites: the adrenal glands and testes and within the prostate tumour. Unlike other chemotherapy agents, it only reduces androgen production without affecting adrenal glands and prostate tumour tissue.
Dosage and Administration
The recommended dose of abiraterone acetate in prostate cancer is 1,000 mg orally once daily in combination with prednisone 5 mg administered orally twice daily. It should be taken on an empty stomach and no food should be consumed for at least 2 hours before the dose and for at least 1 hour after the dose is taken.
Clinical Efficacy
Abiraterone acetate was approved for the treatment of metastatic or advanced prostate cancer based on findings of clinical studies. Clinical studies have demonstrated that treatment with abiraterone acetate can significantly prolong overall survival rates among patients with metastatic prostate cancer who had previously received chemotherapy.
It has also demonstrated clinical efficacy in patients with progressing prostate cancer who had received prior chemotherapy and those who did not receive chemotherapy. It has significantly improved progression-free survival from 8 to 16 months while reducing the need of opiates for pain management and improved health-related quality of life in a study of 1088 patients developing prostate cancer.
Advantages of abiraterone acetate therapy
Abiraterone acetate provides certain advantages for men with metastatic prostate cancer which has spread beyond the prostate area, in comparison to other standard treatments for prostate cancer. These advantages include:
- Life expectancy: Abiraterone acetate has shown to prolong life expectancy and survival. A larger clinical study has demonstrated that about 70 out of 100 men who had received treatment with abiraterone acetate were still alive compared to 50 out of 100 men who had received standard treatment after 3 years.
- Skeletal related event: Abiraterone acetate has a reduced risk of bone fractures compared to other standard treatments.
- Pain: As per a study findings, an increase in pain was less common with abiraterone acetate than with the standard treatment.
Adverse events
- The most common adverse events which may occur after treatment with abiraterone acetate are cough, diarrhoea, hot flushes, dyspepsia, nausea, urinary tract infections, fatigue, headache, joint swelling or discomfort, anaemia, and high blood sugar levels.
- Severe adverse events associated with the use of abiraterone acetate include high blood pressure (hypertension), low blood potassium levels (hypokalemia), adrenal problems, liver problems, fluid retention (edema), and irregular heartbeats.
Warning and Precautions
- Abiraterone acetate can impair fertility, therefore male patients with female partners of reproductive potential should be advised to use effective contraception during treatment.
- Patients with diabetes should be monitored for blood glucose levels, as abiraterone acetate can increase the risk of severe hypoglycemia.
- Closely monitor liver function and consider dose modifications and discontinuation of treatment in patients with moderate to severe hepatic impairment.
- Consider monitoring of blood pressure, serum potassium and symptoms of fluid retention at least monthly and control hypertension and correct hypokalemia before treatment, if present.
- Closely monitor patients with cardiovascular disease.
- Abiraterone acetate can increase the risk of fractures and mortality when used in combination with radiotherapy, therefore it is not advised to use radiotherapy with the combination of abiraterone and prednisone.
- Abiraterone acetate can interact with other drugs, therefore inform your health care provider about the potential drugs you take or the treatment you had received.
We have explored the clinical effectiveness and safety of abiraterone acetate in men with prostate cancer, but it is essential to follow some precautions for reducing the risk of the cancer growing or coming back.
Regular follow up appointments are essential to look for treatment-related adverse events and signs of metastasis. It will also include some imaging tests or scans, depending on your situation and symptoms. Besides these, eating a certain type of diet, taking nutritional supplements and regular exercising can also help in reducing risk of prostate cancer.
Other than this maintain a routine of regular exercise, including different types of yoga. Must include spices, ginger, garlic and other anti-cancer foods in your diet on a daily basis. All these improved and healthy lifestyle habits can help you out to live a healthy cancer free life.
However, if you still want to know more about prostate cancer and tips which can reduce the risk of prostate cancer, you should give a look at this article ‘Prevention measures to reduce Prostate Cancer risk’. It can significantly help you.