Metastatic Prostate Cancer with Charles Ryan, MD and William K. Oh, MD: Case 1 - Episode 9

William Oh, MD: The Efficacy of Abiraterone Plus Prednisone in an Elderly Patient Population

What is the efficacy of abiraterone plus prednisone in an elderly patient population?

Abiraterone/prednisone is a standard treatment for metastatic castration-resistant prostate cancer. The studies have been done in men of all ages, and in fact, I don’t think there’s an upper limit for which you could not use a drug like abiraterone plus prednisone. Again, it has to do with the functionality of the patient and most men in their 80s who are symptomatic from prostate cancer would benefit more from using a treatment like abiraterone than not. And I have not found in my practice that it’s limiting in any way.

Now if the patient has some side effects, for example some baseline liver function abnormalities that might concern you, then that would be an indication to either start at a lower dose or consider an alternative treatment. But in the end I don’t think that the older age of the patient generally influences my decision about whether to use a drug like abiraterone or prednisone.

Of course the prednisone brings its own additional factors into consideration. Prednisone can, for example, worsen hyperglycemia. So in a diabetic, particularly a brittle diabetic, you’d want to be careful and have them monitor their blood sugars. But because the dose of prednisone is so low, I have not found that it’s really a significant barrier to using abiraterone plus prednisone in these patients.

CASE: Metastatic Prostate Cancer (Part 1)

Stanley S is an 83-year-old Caucasian male whose past medical history includes diagnosis of adenocarcinoma of the prostate in 2012 with no evidence of metastasis. At the time, he was started on bicalutamide and his serum PSA levels subsequently decreased to 1.2 ng/ml.

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

  • His serum PSA level is 56.9 ng/ml and his alkaline phosphatase is 258 U/L
  • CT scan shows enlarged lumbar bone metastasis with associated soft tissue component, as well as symptomatic nodes with lumbar bone metastases
  • Biopsies of the prostate and transrectal ultrasound reveal the prostate is 42 grams
  • Ten of 14 cores are positive for prostate cancer for a Gleason score of 8 (4 + 4)
  • His ECOG performance status score is a 2