Steroids while on Abiraterone

[Professorgary]

I have recently switched from Prednisone to Dexamethasone upon psa rise while taking Abiraterone. I was taking 5mg prednisone once daily and now am taking 0.5 mg of dexamethasone. I realized my appetite has increased and I have put on a few pounds in only 6 weeks.

Now, my question is, has anyone on this forum gone without steroids while on Abi? I have researched this and found steroids not necessary if individual side effects are addressed by individual meds. I have also read that studies show that patients who do not take the steroids have a longer overall survival. These studies were based on prednisone.

I think I will cut my Dexamethasone dose to .25 mg one week before my next blood tests. I was only taking half of the usual dose of prednisone so I’m thinking I should be ok for a week and discuss with my MO. It is interesting that Dexamethasone has a long half life (36 to 72hrs) so while you only have .5mg in your system on day one you will have 1.3 to 1.5 on day six.

Any feedback sharing your experience with dose reduction or complete elimination would be appreciated. Thanks, Gary

[Tall_Allen]

It is dangerous to avoid cortisol replacement when taking abiraterone.

prostatecancer.news/2019/06...

[Gearhead]

" I have also read that studies show that patients who do not take the steroids have a longer overall survival." Can you share the source forr this with us?

[Professorgary in reply to Gearhead]

I’m sorry but I read this a few days ago and forget where I read it. If I find it again I will share.

[Mgtd in reply to Professorgary]

I am not sure if the “Professor” indicates your profession but I thought I would share a technique I have used all my life.

When researching anything like my hobbies, professional interests, etc, I keep a divided journal by subject area/interest and note sources and a one or two sentences of why I was interested in this. I restore roadsters as a hobby and this technique works well in potential parts sources or unique ideas that others have tried.

As I have gotten older this has really help me remember and recall details or review prior experiences that both worked and did not work and why.

Hope this is of some value.

[Professorgary in reply to Mgtd]

Not a professor, barely got through high school.lol My friends nicknamed me that because I research everything quite extensively. Thanks for the tip.

[Doctorsceptic]

The reason it is risky and potentially dangerous not to take prednisolone/dexameth replacement is because (while taking Abir) your adrenal will not be able to respond with an increase in cortisol to acute stressors eg infection, trauma etc. In that event cardiovascular collapse and electrolyte imbalance can occur. You should have been advised of this when starting Abir'.

[Professorgary in reply to Doctorsceptic]

I was advised of this but was also advised of other things that did not hold true in my case. For instance I was told I needed to take Xgeva monthly and take a calcium supplement. I refused the calcium supplement because my alp levels were good and calcium was never needed. I was told after I had side effects on Xgeva that I could take it every 12 weeks instead of every 4 weeks as that was found to be non inferior. Hmm, why not do the every 12 weeks to start with. Could it be the four gran per injection? I was only given 5 mg of prednisone once daily for a year and a half and that worked fine but the dexamethasone dose is equivilant to 10 mg of prednision which is why I am considering taking a half dose. And don’t forget the fact that if I lived in Europe my Lupron dose would be exactly half of what I get injected into my body here in the US. I wonder what my MO will say when I ask him if I actually need Lupron while on Abiraterone. That’s gonna be an interesting discussion.

[Doctorsceptic]

All noted!!

[Grandpa4]

why did you quit prednisone. It has a shorter half life and more closely resembles normal steroid production when taken in the morning, Dexamethasone has more side effects because of it longer half life.

[Professorgary in reply to Grandpa4]

Sorry, I hit the wrong button. Explanation below.

[Professorgary]

It was suggested by Dr. Sam Denmeade at JHUH.

A

[ElemanJ]

Pls see these studies. Dexa seems to be a good option in mCRPC.

pmc.ncbi.nlm.nih.gov/articl...

pubmed.ncbi.nlm.nih.gov/300...

[Professorgary in reply to ElemanJ]

Thanks, I have seen several articles about this but not these.