Abiraterone
By Anton J. Bilchik, MD
Medically Reviewed by Matthew Song, PharmD, MBA, MSBA, MPH
Last Update: January 15, 2025
What is Abiraterone?
Abiraterone is an oral medication specifically designed to treat advanced prostate cancer, particularly cases where the cancer has spread beyond the prostate. It targets the production of androgens, such as testosterone, which fuel the growth of prostate cancer cells. Often paired with prednisone, a corticosteroid, abiraterone helps manage side effects and improves the effectiveness of treatment. It is widely used for both metastatic castration-resistant prostate cancer (mCRPC) and metastatic castration-sensitive prostate cancer (mCSPC).
Taken once daily on an empty stomach, this medication offers a convenient and powerful option for managing advanced prostate cancer. Clinical studies show that it significantly slows disease progression and improves survival rates. As an androgen biosynthesis inhibitor, when combined with prednisone, it has been found to reduce the risk of death by approximately 38% in patients, underscoring its critical role in prostate cancer treatment plans.
FAQ
What is abiraterone used for?
It is a medication designed to treat advanced prostate cancer by targeting the production of androgens, which fuel the growth of cancer cells. It is often prescribed with prednisone to help manage side effects and enhance the overall effectiveness of the treatment. By lowering hormone levels, the medication can slow cancer progression and improve patient outcomes.
Key uses of abiraterone:
- Treating advanced prostate cancer (castration-resistant or metastatic).
- Reducing androgen levels to slow cancer growth.
- Used in combination with prednisone to minimize side effects.
Always consult a healthcare provider to determine if this product is appropriate for your treatment plan.
What does it do?
Abiraterone works by blocking the production of androgens, which are hormones like testosterone that can stimulate the growth of prostate cancer cells. Unlike traditional hormone therapies that target the testes, the androgen biosynthesis inhibitor reduces androgen production in the adrenal glands and cancer cells themselves. This comprehensive approach helps slow the progression of advanced prostate cancer, giving patients better control over the disease.
By lowering androgen levels, the drug effectively limits the fuel that cancer cells need to grow and spread. This can reduce symptoms, slow disease progression, and improve overall quality of life. When combined with prednisone, the treatment also helps to manage side effects like high blood pressure or liver problems, making it a more tolerable option for many patients.
What is the chemical classification?
Abiraterone belongs to the class of steroidal compounds and is specifically classified as an androgen biosynthesis inhibitor. It works by targeting a key enzyme called CYP17A1, which is involved in the production of androgens like testosterone. This enzyme inhibition is crucial for reducing hormone levels that fuel the growth of prostate cancer cells.
As a steroidal inhibitor, the medication is uniquely designed to interfere with androgen production at multiple sources, including the adrenal glands, testes, and even within the tumor itself. This broad mechanism makes it highly effective for managing advanced prostate cancer that no longer responds to traditional hormone therapies. Its classification as a CYP17A1 inhibitor highlights its role in disrupting the pathways critical for cancer progression.
Is abiraterone a form of chemotherapy?
Abiraterone is not a form of chemotherapy. While chemotherapy directly kills rapidly dividing cancer cells throughout the body, the drug works differently by targeting the production of androgens, hormones like testosterone that fuel the growth of prostate cancer. It is classified as a hormonal therapy or androgen biosynthesis inhibitor, focusing on blocking the enzyme CYP17A1, which is essential for androgen production.
This targeted approach allows this CYP17A1 inhibitor to manage advanced prostate cancer more effectively with fewer of the systemic side effects typically associated with chemotherapy. Instead of attacking all fast-growing cells, it specifically reduces the hormones that promote cancer growth, making it a valuable option for patients with advanced or castration-resistant prostate cancer.
How long does it work?
The duration of abiraterone’s effectiveness can vary depending on individual factors such as the stage of prostate cancer, the patient’s overall health, and how the disease responds to treatment. In clinical studies, many patients have experienced benefits for several months to a few years, with improvements in disease progression and symptoms when combined with prednisone. Regular monitoring by a healthcare provider helps assess how well the treatment is working over time.
The medication continues to work as long as it effectively controls the cancer without causing significant side effects. It is typically prescribed for advanced prostate cancer that no longer responds to traditional hormone therapies. While it is not a cure, it can significantly improve quality of life and help manage the disease for an extended period, depending on the patient’s unique condition and treatment plan.
What is the life expectancy of abiraterone patients?
The life expectancy of patients taking abiraterone for advanced prostate cancer varies based on factors such as the stage of cancer, overall health, and response to treatment. Clinical studies have shown that this steroidal anti-androgen, when combined with prednisone, can significantly extend survival. In a key study published in The New England Journal of Medicine, patients with metastatic castration-resistant prostate cancer (mCRPC) who received this medication lived a median of 34.7 months, compared to 30.3 months for those on placebo, marking a clear improvement. Additionally, progression-free survival—the time the cancer stays controlled without worsening—was extended by 16.5 months in the abiraterone group.
Further research has demonstrated that in earlier-stage metastatic prostate cancer, this cancer hormonal therapy can extend survival even more significantly. According to a study in The Lancet Oncology, the combination of this drug and standard therapy improved 3-year survival rates to 83%, compared to 76% with standard therapy alone. These findings underline the potential for this androgen biosynthesis inhibitor to improve life expectancy in patients with advanced prostate cancer when used as part of a comprehensive treatment plan. Always consult with a healthcare provider to understand how these statistics apply to individual circumstances.
What are the bad effects?
Abiraterone can cause side effects, some of which may require careful monitoring by a healthcare provider. These side effects occur due to the way the drug blocks hormone production, which can impact other bodily functions. Regular blood tests and check-ups are essential to manage potential risks and ensure the treatment is safe and effective.
Common side effects and their occurrence rates:
- High blood pressure: Affects about 10-15% of patients.
- Low potassium levels (hypokalemia): Seen in approximately 17% of patients.
- Fluid retention or swelling: Occurs in around 22% of cases.
- Liver enzyme increases: Found in up to 10% of patients.
- Fatigue: Experienced by 30-40% of individuals.
For serious concerns, such as heart problems or severe liver damage, immediate medical attention may be required. Always consult a healthcare provider for guidance.
What is the recommended dose?
The recommended dose of abiraterone for treating advanced prostate cancer is typically 1,000 mg (four 250 mg tablets) taken once daily. It is important to take the tablet on an empty stomach, either one hour before or two hours after a meal, as food can increase the amount of the drug absorbed, potentially leading to side effects. The medication is usually prescribed alongside prednisone to help manage side effects like high blood pressure or low potassium levels.
Recommended doses:
- Standard dose: 1,000 mg (four 250 mg tablets) once daily.
- Prednisone dose: 5 mg taken twice daily, as prescribed with abiraterone.
Dosage adjustments may be required based on individual factors such as liver function or the presence of side effects. Always follow the specific dosing instructions provided by your healthcare provider to ensure safe and effective treatment.
How much does abiraterone cost?
As of 2025, the cost of this drug can vary widely based on whether it is the brand-name version, Zytiga, or a generic equivalent. The brand-name medication typically costs around $12,000 for a 30-day supply, making it a significant expense for many patients. However, generic versions of abiraterone are much more affordable, with prices starting at approximately $130-$140 for the same dosage and quantity, depending on the pharmacy and location.
Patients looking to save on costs can explore options such as switching to generic versions, which are therapeutically equivalent and significantly cheaper. Many pharmacies also offer discount programs, and manufacturers may provide copay assistance programs that can further reduce expenses. Discussing financial concerns with a healthcare provider or pharmacist can also help identify additional resources or alternative treatment options to make the medication more affordable.
How effective is this medication?
Abiraterone is effective in extending survival in advanced prostate cancer patients, with studies showing it improves overall survival by approximately 20-25% when combined with prednisone. In a landmark study published in The New England Journal of Medicine, patients with metastatic castration-resistant prostate cancer (mCRPC) treated with this drug experienced a median survival of 34.7 months, compared to 30.3 months for those on placebo, representing a significant improvement in outcomes.
In metastatic hormone-sensitive prostate cancer (mHSPC), this medication has demonstrated even greater effectiveness. Research published in The Lancet Oncology reported that adding this CYP17A1 inhibitor to standard therapy increased the three-year survival rate from 76% to 83%. These findings highlight its role as a vital treatment option for improving survival rates and slowing disease progression in patients with advanced prostate cancer.
Can I use abiraterone and alcohol together?
It is generally recommended to avoid alcohol while taking this steroidal anti-androgen, as combining the two can increase the risk of liver damage and worsen certain side effects. Abiraterone is known to affect liver function, and drinking alcohol can further strain the liver, potentially leading to elevated liver enzymes or more severe complications. Studies have shown that alcohol consumption can exacerbate side effects like fatigue, high blood pressure, and fluid retention, which are already associated with prostate cancer hormonal therapy.
Patients are advised to discuss alcohol use with their healthcare provider before starting cancer hormonal treatment. Medical professionals typically recommend avoiding or minimizing alcohol to ensure the medication works effectively and to reduce the risk of adverse effects. Regular monitoring of liver function through blood tests is essential for patients on this medication, as this helps detect and manage any potential issues early. By avoiding alcohol, patients can better support their overall treatment plan and maintain optimal health during therapy.
What are the brand names for abiraterone?
This drug is available under several brand names and generic options, making it accessible to patients worldwide. The choice of brand may depend on factors like formulation, availability, and cost. Below are the most commonly recognized names for this medication:
Brand names for this medication:
- Zytiga: The most widely known brand for advanced prostate cancer treatment.
- Yonsa: A micronized version for improved absorption and consistent dosing.
- Generic abiraterone: Available under various names, offering a cost-effective alternative.
Your healthcare provider or pharmacist can guide you in selecting the most suitable option based on your treatment needs and budget.
Are there interactions to avoid?
Certain medications and substances can interact with abiraterone, potentially reducing its effectiveness or increasing side effects. This treatment blocks enzymes involved in hormone production, and some drugs may enhance or interfere with its function. To avoid complications, inform your healthcare provider about all medications, supplements, and herbal products you are taking.
Interactions to avoid:
- Strong CYP3A4 inducers (e.g., rifampin, phenytoin, carbamazepine): These can lower the drug’s effectiveness by speeding up its metabolism.
- CYP3A4 inhibitors (e.g., ketoconazole, itraconazole): These may increase the concentration of the cancer growth blocker in the blood, raising the risk of side effects.
- Drugs affecting potassium levels (e.g., diuretics like furosemide, digoxin): Anti-androgen therapy can cause low potassium, requiring careful monitoring when used with these medications.
- Anticoagulants (e.g., warfarin): This combination may alter how blood thinners work, necessitating dose adjustments.
- Herbal supplements (e.g., St. John’s Wort): Can interfere with how the prostate cancer treatment agent is processed by the body.
Consult your healthcare provider to ensure safe use and prevent harmful interactions. Regular monitoring can help manage risks effectively.
What happens when abiraterone stops working?
When this androgen receptor pathway inhibitor stops working, it means that the prostate cancer has become resistant to the treatment, and alternative therapies may be required. Studies suggest that about 20-40% of patients with advanced prostate cancer will eventually develop resistance to abiraterone after a median of 10-16 months of treatment. This resistance occurs because cancer cells adapt and find ways to grow despite the suppression of androgen production. When this happens, the disease may progress, leading to rising PSA levels or the appearance of new symptoms.
In cases where the CYP17 enzyme blocker is no longer effective, oncologists often explore other treatment options such as enzalutamide, chemotherapy (like docetaxel or cabazitaxel), or radiopharmaceuticals such as radium-223. Clinical studies, such as those published in The Lancet Oncology, have shown that switching to enzalutamide after steroidal anti-cancer agent failure can extend progression-free survival by approximately 4-8 months. Regular monitoring and close communication with a healthcare provider are essential to determine the next best steps in managing the disease and maintaining quality of life.
What is the next treatment after abiraterone?
When this androgen synthesis disruptor is no longer effective in managing advanced prostate cancer, the next treatment options typically depend on the patient’s specific condition, overall health, and how the cancer has progressed. Commonly recommended next steps include switching to another androgen receptor-targeted therapy, such as enzalutamide, which works differently from the androgen receptor pathway inhibitor to block the effects of androgens on cancer cells. Studies have shown that enzalutamide can extend progression-free survival by 4-8 months after abiraterone resistance develops.
Other options include chemotherapy with drugs like docetaxel or cabazitaxel, which can target cancer cells more aggressively. In cases of bone metastases, radium-223, a radiopharmaceutical, may help reduce symptoms and improve survival. Clinical trials may also be an option for patients seeking innovative therapies. Your healthcare provider will assess your situation and recommend the most effective next steps to continue managing the disease and maintaining quality of life.
About the Author
Dr. Anton J. Bilchik, MD, is a highly respected Professor of Surgery and Chief of Medicine at the John Wayne Cancer Institute, leading advancements in cancer treatment and research since 2012. Renowned for his expertise in minimally invasive surgery and surgical oncology, he has authored over 200 research publications and continuously secured National Institutes of Health (NIH) grants since 2001. He also serves as Medical Director of the California Oncology Research Institute and a Professor at UCLA’s David Geffen School of Medicine. Dr. Bilchik’s career includes pivotal roles such as Director of Gastrointestinal Surgical Oncology at the John Wayne Cancer Institute. A graduate of the University of the Witwatersrand, Dr. Bilchik completed advanced training at Yale University and UCLA, specializing in surgical oncology and gastrointestinal research. His groundbreaking contributions, blending cutting-edge science with compassionate care, have earned him numerous professional honors and awards, including the Anti-Defamation League’s Humanitarian Award in 2012.
Disclaimer: The content on this page is intended for informational purposes only and does not replace professional medical advice, diagnosis, or treatment. For personalized medical guidance, always consult a licensed healthcare provider before making any changes to your medications, treatments, or overall health regimen. If you have specific health concerns, promptly reach out to your doctor or a qualified healthcare professional.