Here is the answer. I am currently on Prednisolone, so will ask if I can change to Dexamethasone.
Efficacy Comparison
Dexamethasone appears to be more effective than prednisolone in treating castration-resistant prostate cancer (CRPC):
A randomized phase 2 trial compared daily dexamethasone (0.5 mg once daily) to prednisolone (5 mg twice daily) in CRPC patients3.
The PSA response rate was higher with dexamethasone (47%) compared to prednisolone (24%)3.
Median time to PSA progression was longer with dexamethasone (9.7 months) versus prednisolone (5.1 months)3.
Mechanism of Action
Both drugs act as corticosteroids but may have slightly different effects:
Prednisolone is thought to suppress weak androgens of adrenal origin, which may stimulate hormone-sensitive prostate cancer2.
Dexamethasone likely has a similar mechanism, but may be more potent at suppressing adrenal androgens1.
Dosing and Administration
Prednisolone is typically used at doses of 5-10 mg daily25.
Dexamethasone is often given at 0.5-1 mg daily3.
Both are usually combined with other treatments like abiraterone or docetaxel56.
Side Effects
The side effect profiles appear similar:
Common side effects include psychological changes, hyperactivity, and gastrointestinal issues1.
Dexamethasone may cause slightly more psychological effects and hyperactivity compared to prednisolone1.
Clinical Use
Prednisolone is more widely used historically, often in combination with docetaxel or abiraterone56.
Some evidence suggests dexamethasone may be preferable due to potentially greater efficacy3.
Patients who progress on prednisolone may still respond to dexamethasone3.
In summary, while both drugs show activity in prostate cancer, current evidence suggests dexamethasone may be more effective than prednisolone for CRPC patients. However, both remain important treatment options, often used in combination with other therapies. The choice between them may depend on individual patient factors and physician preference.
Written by
Graham49
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A Randomised Phase 2 Trial of Dexamethasone Versus Prednisolone in Castration-resistant Prostate Cancer
Clinical trial registry
EUDRAC 2005-006018-16
Results and limitations
The intermittent dexamethasone arm was dropped after no response was seen in seven patients. By intention to treat, confirmed PSA response was seen in 41% versus 22% for daily dexamethasone versus prednisolone, respectively (p = 0.08). In evaluable patients, the PSA response rates were 47% versus 24% for dexamethasone and prednisolone, respectively (p = 0.05). Median time to PSA progression was 9.7 mo on dexamethasone versus 5.1 mo on prednisolone (hazard ratio: 1.6; 95% confidence interval, 0.9–2.8). In 43 patients with measurable disease, the response rate by RECIST was 15% and 6% for dexamethasone and prednisolone, respectively (p = 0.6). Of 23 patients who crossed over at PSA progression on prednisolone, 7 of the 19 evaluable (37%) had a confirmed PSA response to dexamethasone. Clinically significant toxicities were rare.
Conclusions
Dexamethasone may be more active than prednisolone in CRPC. In the absence of more definitive trials, dexamethasone should be used in preference to prednisolone.
Thank you for this. My husband has his PSA tested monthly. He just had his 4th raised PSA. .51, .61, .75, .85. After the 3rd test , I asked to have him switched from prednisolone to dexamethasone to maybe jumpstart the abiraterone. But was told to just sit tight. Now it’s been 4 progressing PSAs and, oh the doctor is on vacation, wait until next month. Am I being unreasonable to keep pestering them, or is his PSA still low enough that waiting is ok. Based on this study, switching to dex sounds like a wise decision regardless.
Thank you for listening to my complaining. My husbands PSA has been thankfully dropping for 3 years, but now the prospect of him becoming castration resistant is frightening,
I took prednisone with abiraterone as is normal. I was given dexamethazone for the days around each of my Friday docetaxel infusions.
I found the dexamethazone to have a pronounced stimulant effect compared to prednisone, which was so pleasing I would drink espresso along with it to augment that. Lost a bit of sleep on those weekends but it was worth it.
Of course as a 2 days per 3 week prophylactic the dose was much higher than you would take as a sub for daily prednisone, so there’s that. I did read not long ago of a NIH trial experimenting with lowering the effective SOC dosage of dexamethazone in the chemo setting.
Since it was successful, perhaps it was part of a movement to lower the standard dexa dosage from what it was in 2019 when I had my chemo. Maybe the average patient didn’t enjoy it quite as much as I did…
I switched to DEX after prednisone was doing a number on my skin. Dex is way better, helps with appetite and you have more energy. I think it helps with pain better too.
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PTEN loss is not a determinant of time to castration-resistance following androgen-deprivation therapy in prostate cancer
BP with abiraterone + prednisone, eplerenone, dexamethasone
