Fluctuating sugar levels on Zytiga and Prednisone

[Life5]

So, my dad has been on Zytiga and prednisone for 4 months now with a break of 2 weeks recently...in August he was prescribed 1000 mg zytiga and 10 mg prednisone - on 1 month follow up his blood sugar levels were elevated with Plasma Glucose - fasting at 239- so the doc changed the prednisone to 5 mg from 10 mg, thereafter his sugar levels were normal. On November 6, his plasma glucose (random) was normal at 85 but his level enzymes were elevated with SGPT at 140 and total bilirubin at 1.70. The doctor referred us to a gastro ent. and stopped the abiraterone and prednisone for 2 weeks. Post two weeks the lever enzymes were back in control and the doctor advised us to restart 750 mg of zytiga with 5 mg prednisone. Its been two days of taking the medicine and my dad had gone for a medical check up for a tourist visa and they found border line sugar in his urine. He was never diabetic and november 6, blood sugar levels were normal when he was on 5mg prednisone. So is two day intake of the 5mg prednisone causing high sugar levels ?

[LearnAll]

You seem like a caring son who is trying to help his father. Its a difficult situation because if zytiga is working for dad, we should try to retain this med. For that we need to ask an endocrinologist how serious is this rise in blood sugar and what can be done to control it ? Things such as diet change, weight loss, increased physical activity, meds like Metformin and so on.

If its not possible to control blood sugar, then ask oncologist if he is a good candidate for a lutamide medicine such as bicalutamide, enzalutamide etc.

[Life5]

Thanks a lot LearnAll.

Will try to incorporate changes in the diet and motivate him to add exercise to his routine and will get the sugar tested and discuss it with our MO during our next appointment which is due in 15 days.

[tango65]

Prednisone is given with zytiga to try to control the increase in aldosterone and its consequences ( sodium retention, edema, hypertension and hypokalemia). Control of the effects of aldosterone could be done using eplerenone or spironolactone (aldosterone receptor blockers). This approach could help to improve the control of the glicemia.

The increase in liver enzymes is caused by zytiga. It could be temporary and it is not usually associated with chronic hepatitis.

ncbi.nlm.nih.gov/books/NBK5...

[Tall_Allen]

Hyperglycemia is a known adverse effect of Zytiga with prednisone, and of prednisone alone. As long as it's borderline, it only bears watching. If it goes too high, he can try 2.5 mg bid prednisone, but watch out for high blood pressure, low potassium and edema. Or he can switch to Erleada.

[Life5]

Thanks a lot for your replies. Will keep a watch on it and discuss the alternatives suggested with his MO.

[Je1234]

It’s hard watching all of the side effects to the cancer treatments. The steroids cause blood sugar spikes but they can control it with medication. I would think the most important thing is to fight the cancer. Hang in there. Take care.