Abiraterone

What is abiraterone?

Abiraterone acetate (Zytiga®) is a type of hormone therapy for men with prostate cancer that has spread to other parts of the body (advanced prostate cancer). 

Abiraterone works by stopping the body producing testosterone. It does this in a different way than other types of hormone therapy. In most men, prostate cancer cells can’t grow without testosterone, even if the cancer has spread to other parts of the body.

Abiraterone won’t cure your prostate cancer, but it can help keep it under control and has been shown to help some men live longer. It can also help to treat or delay symptoms, such as pain and tiredness.

Who can have abiraterone?

Abiraterone is usually offered to men whose cancer has stopped responding to other types of hormone therapy. But you may be offered abiraterone as a first treatment for advanced prostate cancer.

If you’ve had another type of hormone therapy called enzalutamide, abiraterone may not be suitable for you. Read more below.

Abiraterone after hormone therapy

Abiraterone is a treatment for advanced prostate cancer. It is most commonly offered to men whose cancer has stopped responding to other types of hormone therapy. You may hear this called hormone-relapsed or castrate-resistant prostate cancer.

Your doctor may offer you abiraterone if you can’t have chemotherapy, or you don’t want to have it yet. Or you may be offered abiraterone if you’ve had a chemotherapy drug called docetaxel, and your cancer has stopped responding to it.

Abiraterone as a first treatment

There is evidence that some men may benefit from having abiraterone when they are first diagnosed with advanced prostate cancer. You may hear this called hormone-sensitive prostate cancer, as the cancer is likely to respond to standard hormone therapy.

Abiraterone is available on the NHS in Scotland as a first treatment for some men with advanced prostate cancer.

In Scotland and Wales, abiraterone is available as a first treatment if you have localised or locally advanced prostate cancer that has a high risk of spreading. 

In  England and Northern Ireland, abiraterone isn’t currently available for these men as a first treatment option.

If you have just been diagnosed with localised, locally advanced, or advanced prostate cancer your doctor will talk to you about your treatment options.

Abiraterone or enzalutamide?

Abiraterone and enzalutamide are both types of hormone therapy that treat advanced prostate cancer, but they work in slightly different ways.

Your doctor will talk to you about which drug is most suitable for you. For example, abiraterone may be a better option than enzalutamide if you’ve had:

• any falls
• any seizures (fits) or you have an increased risk of seizures
• extreme tiredness (fatigue)
• problems with memory or concentration.

This is because enzalutamide can increase your risk of these problems.

But enzalutamide may be a better option than abiraterone if your cancer has spread to the liver or lungs, or if you can’t take steroids. Abiraterone must be taken with a steroid.

Some men prefer to take abiraterone because it is less likely to cause tiredness than enzalutamide. But some men find enzalutamide easier to take because, unlike abiraterone, you don’t need to take it on an empty stomach and you don’t need to take steroids.

I’ve had enzalutamide, can I have abiraterone?

If you’ve already had a type of hormone therapy called enzalutamide, abiraterone probably won’t be an option. This is because research suggests that men who have already had one of these drugs don’t benefit from the other drug.

However, if you get severe side effects from enzalutamide, you may be able to try abiraterone.

Speak to your doctor or specialist nurse about which treatments might be suitable for you and when to have them. You can also talk things through with our Specialist Nurses.

If you’re having trouble getting abiraterone, even though your doctor thinks it is suitable for you, please let us know.

Other health problems and medicines

Tell your doctor about any other health problems you have. You should also tell them about any other medicines you’re taking or have taken recently, including any painkillers, such as codeine and tramadol. This is because abiraterone may affect how other medicines work. And some medicines can affect how well abiraterone works. Your doctor will talk to you about which prostate cancer treatment would be best for you.

If you have heart or liver problems, you may not be able to take abiraterone. If you have high blood pressure or a low level of potassium in your blood, you may need treatment for these before you start taking abiraterone.

If you have diabetes, the steroids that you need to take alongside abiraterone may increase your risk of high blood sugar levels. Your doctor or nurse may advise you to check your blood sugar levels more regularly than usual. If you take tablets or insulin to treat your diabetes, your doctor may suggest taking enzalutamide instead of abiraterone.

Other treatment options

If abiraterone isn’t suitable for you, or if you choose not to have it, your doctor may offer you a different treatment.

If you’ve just been diagnosed with advanced prostate cancer, other possible treatments may include:

• chemotherapy with hormone therapy
• hormone therapy alone
• clinical trials.

Some men may also be offered radiotherapy together with their main treatment.

If you have advanced prostate cancer that has stopped responding to standard hormone therapy, other possible treatments may include:

• enzalutamide– this probably won't be an option if you had abiraterone when you were first diagnosed
• chemotherapy (docetaxel or cabazitaxel)
• steroids 
• radium-223
• olaparib
• very rarely, oestrogens.

Speak to your doctor about your treatment options. They can also tell you about any clinical trials that might be suitable for you.

Read more about treatment options after your first hormone therapy.

Advanced prostate cancer can cause symptoms, such as bone pain. Speak to your doctor or nurse if you have symptoms – there are treatments available to help manage them.

What does treatment involve?

Abiraterone is usually taken as two tablets, once a day. Swallow the tablets whole with water. It’s important not to chew, break or crush the tablets.

You should take the tablets on an empty stomach, at least two hours after eating. You shouldn’t eat anything for at least one hour after taking the tablets. This is because food can affect the way your body absorbs abiraterone. You could take the tablets an hour before breakfast.

You will also take a steroid called prednisolone or prednisone, usually as a tablet twice a day with food. This lowers the risk of some side effects.

If you've just been diagnosed with advanced prostate cancer, you will usually have another type of hormone therapy alongside abiraterone. For most men, this other hormone therapy will be a monthly or every three to six months injection.

If you've previously been on hormone therapy that has stopped working so well, you will probably start taking abiraterone alongside your original hormone therapy. This will still help to keep the amount of testosterone in your body low and may help abiraterone to work. Read more about what happens when your first hormone therapy isn’t working so well.

How long will my treatment last?

You will continue taking abiraterone until it stops working or if you get severe side effects. You will have a prostate specific antigen (PSA) blood test  to see if abiraterone is still working.

What are the side effects?

Like all treatments, abiraterone can cause side effects. These may affect each man differently, and you’re unlikely to get all the possible side effects. Before you start treatment, your doctor or nurse will explain the possible side effects. Knowing what to expect can help you deal with them. You can find more information in the leaflet that comes with your medicine or from the Electronic Medicines Compendium.

Common side effects include:

• a build-up of fluid in your body (fluid retention), which can cause swelling in your legs or feet
• a drop in the level of potassium in your blood, which can cause weakness or twitches in your muscles, or a fast, pounding heartbeat – speak to your doctor straight away if you notice these symptoms
• liver problems
• high blood pressure
• urinary tract infection
• diarrhoea.

Less common side effects include:

• high levels of fat in your blood
• chest pain
• heart problems
• severe infections
• indigestion
• blood in your urine
• skin rashes
• broken bones.

Your doctor will check your blood pressure and give you regular blood tests while you are taking abiraterone to check for any problems with your heart, liver or potassium levels.

Taking a steroid together with abiraterone lowers the risk of some side effects, such as high blood pressure, having too much water in your body and a lower level of potassium in your blood. But steroids can cause other side effects.

Taking abiraterone may cause your bones to get thinner and weaker over time. You can help keep your bones strong and reduce your risk of severe bone thinning (osteoporosis) by making changes to your lifestyle. If you already have osteoporosis, your doctor may suggest taking medicines, such as bisphosphonates, to help reduce the risk of broken bones.

Speak to your doctor or specialist nurse if you have any side effects from taking abiraterone, even if they’re not listed here. They may offer you other treatments to help manage any side effects.

Contraception

If you’re sexually active and there is a chance your partner could become pregnant, use a condom together with another form of contraception while you are taking abiraterone and for three months after. If your partner is pregnant, you should use a condom if you have sex, as abiraterone could harm the baby.

What happens next?

You may have a prostate specific antigen (PSA) blood test at least every two or three months while you’re taking abiraterone to check how well your treatment is working. You may also have blood tests to check for any problems with your potassium levels or liver, as well as blood pressure checks at least once a month. Ask your doctor which tests you will have and how often you’ll have them.

Your PSA levels alone aren’t usually enough to know if your treatment is working. Your doctor will use your PSA level and any other test and scan results, along with information about how you’re feeling, to check how well the treatment is working. Tell your doctor or nurse about any side effects you’re having, as there may be ways of managing these.

If your PSA level falls, this usually suggests your treatment is working. How quickly the PSA level falls, and how low, will vary from man to man.

In some men, the PSA level won’t fall. This alone doesn’t mean that abiraterone isn’t working. Your doctor will also ask you about any symptoms you’re having. You may have scans, such as a CT, MRI or bone scan, particularly if your PSA level is rising. Your doctor may suggest you keep taking abiraterone or, if they’re concerned the cancer is growing, they may talk to you about other treatment options.

For more information about abiraterone, speak to your hospital doctor or specialist nurse, or to our Specialist Nurses.

References

Updated: September 2023 | Due for Review: September 2026