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). It is usually only offered to men whose cancer has stopped responding to other types of hormone therapy – you may hear this called second-line therapy. But some men might be offered abiraterone as a first treatment for advanced prostate cancer.

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

Abiraterone may be suitable if you have no symptoms or mild symptoms. Your hospital 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.

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 respond so well to the other drug. However, if you get severe side effects from enzalutamide, you may be able to try abiraterone.

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

Earlier abiraterone

There is evidence that some men may benefit from having abiraterone at an earlier stage, 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.

In England, Wales and Northern Ireland, abiraterone isn’t usually available for these men. But during the current coronavirus outbreak, you may be offered abiraterone instead of chemotherapy. This is because chemotherapy can increase your risk from catching infections, including coronavirus. Chemotherapy also involves regular hospital appointments, which could put you at risk of catching coronavirus during those hospital visits.

Abiraterone doesn’t affect your immune system or involve regular hospital visits. For this reason, abiraterone may be safer for you than chemotherapy until the risk from coronavirus in the UK has reduced.

Abiraterone is routinely available on the NHS in Scotland as a first treatment for advanced prostate cancer. In Wales, you may be offered abiraterone instead of chemotherapy during the coronavirus outbreak. If you live in England or Northern Ireland, you'll probably be offered a different type of hormone therapy called enzalutamide. But if you get severe side effects from enzalutamide, you may then be offered abiraterone instead.

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 hospital 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.

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.

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 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 one of the main treatments listed above.

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
• less commonly, 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.

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 three-monthly 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 help to keep the amount of testosterone in your body low and may help the abiraterone to work. Read more about what happens when your first hormone therapy isn’t working so well.

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.

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 about 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 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 an MRI scan or CT 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: May 2020| Due for Review: May 2023