ONCAlert | 2018 SGO Annual Meeting on Women’s Cancer
Prostate Cancer Case Studies

Charles Ryan, MD: The Role of Abiraterone Plus Prednisone in Patients With Diabetes

Charles Ryan, MD
Published Online:Jul 19, 2016
Mathew J is a 61 year old African American male who presented to his primary care physician with lower urinary tract symptoms, including sporadic hematuria. He complains of abdominal pain and low back pain starting four months ago and increasing in frequency.

Metastatic Prostate Cancer with Charles Ryan, MD and William K. Oh, MD: Case 2

Metastatic Prostate Cancer with Charles Ryan, MD and William K. Oh, MD: Case 1
Metastatic Prostate Cancer with Charles Ryan, MD and William K. Oh, MD: Case 2


Is abiraterone plus prednisone a concern considering the patient's history of diabetes?

Patients with diabetes can still take abiraterone and prednisone. They need to be monitored. They need to be monitored even if they’re not on abiraterone and prednisone, so the monitoring doesn’t really change all that much. In this case, the patient is taking metformin, which is a very commonly used generic drug for diabetes. There’s actually retrospective data that may suggest that men who have diabetes who take metformin who have prostate cancer are at less risk of dying of their prostate cancer, so I wouldn’t alter the metformin. I would work closely, hopefully, with his primary care doctor or his endocrinologist to make sure that the diabetes is adequately controlled. The 10 mg of prednisone that is used with the abiraterone may increase his blood sugars slightly, but keep in mind that the prednisone of 10 mg is not a significant dose above and beyond the daily glucocorticoid production in the normal human. We’re not talking about high doses of steroids that would be likely to cause significant diabetes complications.

CASE: Metastatic Prostate Cancer (Part 2)

Mathew J is a 61 year old African American male who presented to his primary care physician with lower urinary tract symptoms, including sporadic hematuria. He complains of abdominal pain and low back pain starting four months ago and increasing in frequency. Prior medical history includes non-insulin dependent diabetes mellitus, well-controlled on metformin since 2006. The patient was referred to urology for further evaluation. ng/ml.

During his most recent follow-up exam, the patient complained of intermittent back pain and increasing fatigue.  

  • Digital rectum exam revealed nodular prostate /L
  • Serum PSA level; 129 ng/ml
  • Alkaline phosphatase, 258
  • TRUS/prostate biopsy: 53 gram prostate, 12/12 cores (+), Gleason 4 + 5
  • CT indicates blastic lesions to lumbar spine and pelvis
  • Bone Scan positive for T/L spine, pelvis, right femur, scapula
  • ECOG performance status, 1

 

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