I realize this is just my experience and I don't know if there's any scientific data behind it but in case this might help someone I wanted to post it.
I apparently have become castrate resistant and have restarted Abiraterone about 4 months ago. This is my second time I've been on Abi and this time my SE's are much less severe than the first, expect for fatigue. I found that I was increasingly feeling fatigue to point I was having urges to take multiple short naps per day.
So, I started some investigations into this and landed on my prednisone dosage. I found that one reason prednisone is given with Abi is because Abi blocks cortisol production and prednisone is given to help replace that lost cortisol. One of the effects of low cortisol can be increased fatigue.
My MO had me on 5 mg/day which is what I had before when I was castrate sensitive but I saw that the normal dosage when castrate resistant is 10 mg/day. So I messaged my MO about this, who replied almost immediately (I love how responsive my MO is) that I should give it a try and start with the 10 mg. I started feeling noticeably more energetic very quickly, to the point I almost feel like my old self, albeit a 65 yo self. I relayed that to my MO and he's now bumped up my prescription to 10 mg. I don't know why more prednisone may be needed when castrate resistant or what my MO's thinking was to keep me on 5 mg. But I definitely feel more energetic. I'm actually back out getting in some runs on a regular basis now.
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fireandice123
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5mg is normal replacement dose. Actually closer to 4mg. 10 mg will have more serious side effects like bone loss, weight gain, glucose intolerance, diabetes in some, cataracts, ect. . These side effect might be worth it to you. Personally I would try and treat the fatigue with exercise. You are hearing this from a retired rheumatologist who watched people take steroids for arthritis. They all loved prednisone in the beginning.
Oh I will definitely be having a longer conversation about this with my MO. I'm concerned about taking more meditations. I get trying to overcome fatigue with exercise. I exercise 6 days/wk, 7 if you count taking my dog on walk. I run, weight train, and swim but that's not helping. I used to be a hardcore runner. I've run 14 full marathons and countless other shorter races and I was always a proponent of the old Nike slogan - Just Do It. Suck it up and do it even if you don't feel like it. This time I find I can't just do it if I don't have the energy.
Also, I've read from multiple sources that 5 mg is the dosage for Castrate/Hormone Sensitive patients but 10 mg is the dosage for Castrate/Hormone resistant patients. Don't know what there's a difference. One reference is below.
When it stops working they do often try higher doses. It sometimes helps. Life expectancy in that group is shorter so not as worried about side effects although some still live a long time.
Just something more to consider. You may want to consult with an endocrinologist. My husband was diagnosed with Adrenal insufficiency, severe fatigue after discontinuing Abi and Prednisone. Thyroid panel did not pick this up. ( He had previously been treated for PCa in one adrenal gland, as a mitigating factor too) but just a thought.
Thanks. That's good info. I really don't like taking any medications and it goes against my inclinations to want to increase any medications. Before I was dx'd at age 58 I was on no medications and hated the idea of taking any meds at all.
I went off pred when I stopped Abi. Yes, I tapered but I was wiped out. I was on 10 mg of pred because of low cortiosol. I went back on 10 and I feel so much better. My hematologist said my adrenals will not produce cortisol anymore because they were shut down for so long.
I hear you on this, I could nap all day if given the chance...just recently had my 5 mg dose reduced to 4 mg...1 mg does make a difference...I'm on it for Adrenal insufficient due to prolonged treatment with PD1 immune Checkpoint inhibitors immunotherapy...that damaged my bodies ability to produce Cortisol, left to my discretion to stop or not but blood sugar in am has to be tested daily, that 1 mg was taken at bedtime.
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