The role of abiraterone acetate in the management of prostate cancer: a critical analysis of the literature.

CONTEXT

The development of agents targeting androgen signalling holds promise for men with castration-resistant prostate cancer (CRPC).

OBJECTIVE

The emerging role of abiraterone acetate (AA), a novel, orally administered androgen synthesis inhibitor, is critically analysed.

EVIDENCE ACQUISITION

Data were acquired from critically important original research published in peer-reviewed literature or presented at conferences conducted by the American Society of Clinical Oncology and the European Society of Medical Oncology.

EVIDENCE SYNTHESIS

The major findings are addressed in an evidence-based, objective, and balanced fashion.

CONCLUSIONS

AA specifically inhibits CYP17 and substantially reduces serum androgen levels without inducing significant adrenal insufficiency. A phase 3 trial reported a significant extension of survival in metastatic CRPC with AA plus prednisone compared to prednisone alone following docetaxel. The primary toxicity of mineralocorticoid excess is manageable. The addition of low-dose corticosteroids to AA may be necessary for controlling symptoms of mineralocorticoid excess.