Question on ketoconazole

I'd like to ask a question of those who have taken or are taking ketoconazole. How long does it take to take effect? I am concerned because after two months of use, my PSA has not come down significantly. I started the high dose of 400 mg three times a day two months ago when my PSA was 17. After one month, it came down to 12 and I was encouraged, thinking that maybe it just takes a while to reach nadir. Then a few days ago at the end of the second month, I had my PSA checked and it is back to 15. Is there something I am doing wrong?

20 Replies

  • It seems to be working just fine as long as you keep getting better numbers. I was on it for 8 years and it was very effective. The expert on this treatment is Dr. Myers on Charlottesville Virginia, you should pay him a visit.

  • Hi Johnstonearch,

    Thanks for your very encouraging reply. Did you take keto right off the bat or was it after the failure of antiandrogens like Lupron, Casodex etc?

  • According to the original clinical trial information---the conclusions are for a more than 50% of the participants had PSA reductions after 8 months---so you may need to wait it out.

    One way to attack Adrenal T, is to take Avodart---which interferes with the T converting to DHT--which is food for prostate cancer cells. Dr. Snuffy Meyers is an advocate of Avodart with Casodex and Lupron in the initial stage of Hormone suppression. I am on the same program---you may have been on the 3 drug cocktail--prior to the use of Ketoconazole. That is all I know.


  • I never had or knew about Avodart until I joined this community a few weeks ago. But if it is a suggestion for the initial stages, I am past that already. I had successful Hormone suppression for 11 years following proton beam radiation. Early this year I reached castrate resistance so I was prescribed Ketoconazole. I hope I am just one of the 50% that need to wait it out. At least my PSA has stayed steady at the lower teens and not gone higher than the 17 when I started two months ago. Thanks for your feedback.

  • You can go on line by putting search topic ]Keteconazole and Prostate Cancer], find the Clinical trial work--and as I said from reading it myself---full drug efficiency--takes 8 months.


  • I will do as you suggest. Although not necessary as I take your word, I might find additional details to share with my oncologist. Although she is not a specialist in prostate cancer, she treats me with respect unlike many, if not most, doctors who get defensive when they have a patient who knows so much, sometimes more than they. Ha! Ha!

  • Just had my monthly Doc. visit, this morning---I brought up the Ketoconazole. He told me it was used before Lupron and Casodex was available. A matter of fact he told me the question of Ketoconazole was on his final board exams. The question was what do you prescribe when prostate cancer is discovered and removal by surgery follows? The answer was Ketoconazole. He actually pulled out an old medical book and it indicated it was for Androgen Deprivation from all sources---so back then 30 plus years ago--it was a key drug to knock down PSA--which was not a measurable diagnostic test at that time----interesting? I then educated my Doc on 5-Loxin---and I will send him the research I have on its ability to kill prostate cancer cells in vivo, and in vitro in mice--while being a substitute for alleve---for pain relief of arthritis. The original source of 5-Loxin is frankincense---found 17 times in the Bible--the actual source for frankincense which is Boswella Serrata herb---the 5-Loxin is extracted out of the Boswella/Frankincense. Just throwing out another material, some of us using supplements with their drugs may consider. Had another undetectable PSA---thanking God!


  • Interesting information, thank you. Ketoconazole works differently than anti-androgens like Lupron, Eligard, Zoladex, Casodex and the like. Keto lowers testosterone by blocking the action of androgen receptors. So it is prescribed when the anti-androgens stop working, which is what happened to me after 14 years on Zoladex and Casodex. I am hoping to solve my problems with Keto by following suggestions like taking it with acidic drinks like Coca Cola and ginger ale, which allegedly improve absorption. Even if I don't reach undetectable PSA as long as I can lower it to single figures. Better than having to move to chemotherapy which I am not qualified for yet because my recent scan showed no metastasis.

  • Yes--you got it all right--it is just the 8 month wait, to see full potency as to PSA--I get my PSA every 30 days--I am on Medicare--and my Doc--has a way to do it so I do not pay---I would, if you want to see my PSA every 30 days. Other than that Good Luck and God Speed!!


  • Another note---I am not a Doctor--but suggest the use of Pectasol-C--this is a strong anti-angiogenesis material--as your PSA would indicate you have enough activity, to try to prevent the Pca cells from agglomerating somewhere, or landing in a bone. You can read about the Phase Trial 2 Test in Israel and the Phase Trial 3 Test in the USA, currently ongoing--I started my 4th month.


  • I according to my Researcher Medical Oncologist, Ketoconazole does have Prostate Cancer killing properties. However, his research showed that it is best used in combination with other agents that also have Cancer killing properties. I took Keto every day for three cycles during a six month trial.

    The combination therapy which I received was a part of a Clinical Trial and was as follows:

    Each course of chemotherapy lasts for 8 weeks. Patients were treated in weeks 1, 3, and 5 with Doxorubicin 20 mg/m2 as a 24-hour intravenous infusion on the first day of every week in combination with Ketoconazole 400 mg orally 3 times a day daily for 7 days. In weeks 2, 4, and 6, treatment consisted of Paclitaxel 100 mg/m2 intravenously on the first day of every week in combination with Estramustine 280 mg orally 3 times a day for 7 days. During the 24 weeks 30 mg of Prednisone were taken orally in two doses, 10 mg and 20 g. Hormone management with either Lupron or Eligard was initiated at the start of chemotherapy. I remained on Lupron/Eligard for six years. After completion of 3 courses of chemotherapy, Casodex was administered daily in two doses, 10 mg and 20 mg for eight months.

    After 12 years since the start of the trial, my metastatic lesions are resolved and my PSA is still undetectable. Two years after the cessation of hormone injections, I started 4 mg of Androgen to boost my Testosterone. My testosterone level is approx. 480. I have complete blood analyzed every four months.

    Gourd Dancer

  • Thanks for your very informative reply. My oncologist prescribed Keto because I am supposedly in the transition stage from CRPC to mCRPC. Before prescribing it, she had body scan done on me which showed no metastasis, which is good. So unless the body scan was not accurate, I am not ready for chemotherapy. Plus if it gets to that point, God forbid, I have a big decision to make. I am 77 years old and have lived long enough and prefer quality of life over longevity given a choice.

  • Good for you. Before I had seeds implanted I had a bone scan and abdominal cramps scan. No mets. 12 months later two mets. Medical Oncologist told me that it did not matter which primary I had, it was too late. Then he explained micro metastasis caused by cancer cells floating around in the lymph and vascular systems look for a place to land and multiply

    Hopefully you will not experience that scenario. At 58 I took a very aggressive posture in treatment of the Stage 4 Prostate Cancer. I also glad that I did and was able to find a remarkable researcher.

    Keep kicking the bastard.


  • I was diagnosed with 24 PSA and Gleason 8 in May, 2002. Fortunately, I found proton beam therapy at Loma Linda for my primary and got there in November. Before going there, I was on preadjuvant hormone blockade therapy (Zoladex) on the advice of my urologist while I was searching for answers. Before Loma Linda started my treatment, they had an abdominal scan to rule out lymph involvement and fortunately I passed. But because of my high diagnosis stats, they gave me a triple part protocol of proton, photon and advice to go on hormonal blockade (Zoladex and Casodex) So I had that but instead of going continuously for 24 months, I elected intermittent androgen blockade (IAB) and that worked well for me until early this year. So counting from mid 2002 post diagnosis to today, I have so far beat the bastard for 14 years and still no signs of metastasis. I also read that the median lifetime of Keto before reaching mCRPC is 18 months. I hope to have that or even longer. I have a friend who took it for 7 years until he had to move on to Xtandi.

  • My husband was on Lupron + ketoconazole + high dose prednizone. At the start his PSA was 10.1, after a month and a half it was 4.2, at two months 1.7, then stayed at 0.7 for six months before starting to shoot back up. One medicine does not work for all men with mPCA all the time.

  • Thanks for your reply. I hope for the best for your husband. I just started Keto after 14 years post diagnosis, proton beam radiation and intermittent androgen blockade. I am not metastatic yet and hope will continue to hold off with Keto.

  • It's a roller coaster journey we've been on for 7 years when he was diagnosed GS 9, PSA 40 with lymph node involvement between the kidneys and aorta that no one locally would touch with surgery or radiation. His doubling time after the Extandi failed was 2 months. We just tried VT-464 on a clinical trial and had to quit because the side effects got too serious: metabolic encephalopathy that hasn't disappeared after one month off the drug. All the drug did was stabilize the PSA at the level before starting it for 4 months.

  • I remember with keto it was important to take it with a acetic beverage , like coca cola to increase absorption

  • Thanks. I do remember coming across that in my research. I have ginger ale and that should help

  • Yes I believe other than coke or pepsi I believe ginger ale to be the most acetic

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