Abiraterone and spironolactone in prostate cancer: a combination to avoid

ABSTRACT

Objectives: Disease progression in metastatic castration-resistant prostate cancer (mCRPC) is dependent on androgen signaling. This case describes the complex adaptive androgen signaling mechanisms in mCRPC and illustrates that caution should be exercised when treating these patients with drugs influencing the androgen axis.Methods: Single case report and review of the literature.Results: We report the case of an 86-year-old man with mCRPC, treated with the secondary antihormonal agent abiraterone acetate. Following association of spironolactone to deal with symptoms related to mineralocorticoid excess, biochemical and radiographic disease progression occurred. Spironolactone was discontinued and 8 months after withdrawal, the patient continues to show a biochemical response to abiraterone.Conclusions: Although spironolactone generally exerts anti-androgenic effects, experimental evidence exists that it acts as an androgen receptor agonist in an androgen-depleted environment, capable of inducing prostate cancer proliferation. This is supported by the observations described in this case report. Therefore, spironolactone should be avoided in prostate cancer patients suffering from treatment-associated side effects of abiraterone.

KEYWORDS:

• Abiraterone
• CYP17
• mineralocorticoid excess
• spironolactone
• prostate cancer
• androgen receptor

Acknowledgments

This work was supported by the Fund for Scientific Spearheads of Ghent University Hospital and “Kom op tegen Kanker (Stand up to Cancer), the Flemisch cancer society” (Bert Dhondt: Emmanuel Vander Schueren Research Grant).

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Fund for Scientific Spearheads of Ghent University Hospital;Kom op tegen Kanker (Stand up to Cancer), the Flemisch cancer society [Emmanuel Vander Schueren Research Grant];

Notes on contributors

Bert Dhondt

Bert Dhondt, MD, is a physician in training in the department of Urology, Ghent University Hospital and PhD researcher in the Laboratory of Experimental Cancer Research, Ghent University.

Sarah Buelens

Sarah Buelens, MD, is a physician in training and PhD researcher in the department of Urology, Ghent University Hospital.

Jeroen Van Besien

Jeroen van Besien, MD, is a physician in training in the department of Urology, Ghent University Hospital.

Matthias Beysens

Matthias Beysens, MD, is a physician in training in the department of Urology, Ghent University Hospital.

Elise De Bleser

Elise de Bleser, MD, is a physician in training in the department of Urology and PhD researcher in the Department of Radiation Oncology, Ghent University Hospital.

Piet Ost

Piet Ost, MD, PhD, is a staff member in the Department of Radiation Oncology, Ghent University Hospital.

Nicolaas Lumen

Nicolaas Lumen, MD, PhD, is a staff member in the department of Urology, Ghent University Hospital.