ONCAlert | 2018 ASCO Annual Meeting
Prostate Cancer Case Studies

William Oh, MD: The Role of Abiraterone Plus Prednisone in Patients With Diabetes

William Oh, MD
Published Online:Jul 21, 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 and prednisone a concern considering the patient's history of diabetes?

Diabetes is a relative contraindication to the use of abiraterone/prednisone. But in my practice and in my experience with the drug, the dose of prednisone, 5 mg twice a day, is really so low that it has not had any major impact if the patient’s diabetes is relatively well controlled. Of course this is going to vary from patient to patient. It’s going to vary based on his diet and how many diabetes medicines he’s on. I think a brittle difficult-to-control diabetic probably should not get abiraterone or prednisone. But for most patients it’s really not an issue. And even if a patient is on diabetic medications, as long as their blood sugars are reasonably well controlled, 5 mg twice a day of prednisone is not, in my opinion, a real contraindication as long as you continue to monitor their blood sugars.

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

 

Publications
Copyright © TargetedOnc 2018 Intellisphere, LLC. All Rights Reserved.