title: Corticosteroids in the management of prostate cancer: a critical review.
abstract: Corticosteroids have been used in the management of prostate cancer for over 30 years. Although daily oral corticosteroids have frequently used in conjunction with chemotherapy for metastatic castration-resistant prostate cancer, their independent impact on survival is unclear. However, corticosteroids confer palliative benefits and are associated with objective responses and circulating tumor cell (CTC) and PSA declines in a small minority of patients, although toxicities such as osteoporosis and immunosuppression complicate long-term use. Following the demonstration of a palliative benefit for mitoxantrone combined with corticosteroids compared with corticosteroids alone, subsequent trials that demonstrated a benefit for first-line docetaxel over mitoxantrone, and second-line cabazitaxel over mitoxantrone, administered concurrent daily oral corticosteroids with all of these agents to maintain uniformity. Conversely, improved outcomes were demonstrated with docetaxel without corticosteroids for metastatic castration-sensitive prostate cancer. Daily oral corticosteroids are routinely combined with abiraterone to mitigate symptoms of mineralocorticoid excess. In contrast daily corticosteroids are not essential when administering enzalutamide or radium-223, and there is a concern of deleterious immune effects concurrently with sipuleucel-T. Given emerging evidence for promotion of resistance mechanisms, routine administration of daily oral corticosteroids in settings other than abiraterone administration and palliation of symptoms is probably not required.
authors.affiliation: Department of Medicine, Section of Hematology-Oncology, University of Alabama at Birmingham (UAB) Comprehensive Cancer Center, Birmingham, AL, USA.
authors.forename: Chukwuma
authors.initials: C
authors.lastname: Ndibe
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wang
authors.forename: Guru
authors.initials: G
authors.lastname: Sonpavde
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000736:Androstenes / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000077143:Docetaxel; D019008:Drug Resistance, Neoplasm; D006801:Humans; D008297:Male; D008942:Mitoxantrone / Q000008:administration & dosage; D010166:Palliative Care / Q000379:methods*; D011241:Prednisone / Q000627:therapeutic use*; D064129:Prostatic Neoplasms, Castration-Resistant / Q000188:drug therapy* / Q000401:mortality; D043823:Taxoids / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000736:Androstenes; D043823:Taxoids; D000077143:Docetaxel; C552428:cabazitaxel; D008942:Mitoxantrone; C089740:abiraterone; D011241:Prednisone