Abiraterone Is The Strongest Weapon Against Prostate Cancer

Abiraterone stepped in when other treatments weren’t cutting it for advanced prostate cancer. Since it was approved in 2011, it’s provided a smarter way to treat advanced cancer by targeting the hormones that make it grow. This means a more effective treatment with fewer side effects for patients.

Origins of Abiraterone and the Endocrine Roots of Prostate Cancer

Prostate cancer has long been linked to the body’s production of androgens, like testosterone. 

In the 1940s, researchers found that lowering androgen levels could slow prostate tumor growth. This led to strategies like surgical castration and, later, medical castration with drugs like LHRH agonists. These treatments aimed to reduce testosterone, which fuels most prostate cancers in early stages. 

Over time, however, tumors adapted. Even with low testosterone from the testes, cancer cells found ways to keep growing. Scientists discovered that prostate cancer could use alternative sources of androgens, such as those produced by the adrenal glands or within the tumor itself. This local hormone production explained why some patients developed castration-resistant prostate cancer (CRPC), a form that no longer responded to traditional hormone therapy. 

In the end, this understanding paved the way for abiraterone. Researchers began targeting not only testosterone from the testes but also androgen production from all sources. The goal was to block the entire androgen pathway, stopping hormone production at every step.

Abiraterone's Mechanism of Action

Abiraterone acetate works by hitting a key enzyme in the androgen production line: CYP17A1. This enzyme plays a central role in synthesizing both adrenal and intratumoral androgens. 

Specifically, CYP17A1 is involved in two separate but critical steps: 17α-hydroxylase activity and 17,20-lyase activity. Both are essential for creating precursors that eventually become testosterone and other androgens. By blocking CYP17A1, abiraterone effectively stops androgen production not just in the testes (which traditional therapies already targeted) but also in the adrenal glands and within the prostate tumor itself. This comprehensive suppression cuts off the fuel source for many prostate cancer cells, including those that have become resistant to standard hormone therapies.

However, blocking CYP17A1 also disrupts other hormonal pathways, especially those related to corticosteroids. Without compensation, this can lead to a rise in mineralocorticoids, causing side effects like hypertension, fluid retention, and low potassium. That’s why abiraterone is always given with a low dose of prednisone, a corticosteroid that helps restore hormonal balance and prevent these side effects.

The precision of abiraterone’s mechanism- shutting down androgen production at the enzymatic level- marked a new kind of targeted therapy. Instead of just lowering hormone levels, abiraterone now stops the body from making androgens altogether, directly blocking their creation. This approach made it a more effective treatment overall.

The Early Success of Abiraterone in Prostate Cancer Treatment

Before abiraterone, advanced prostate cancer treatments were limited and provided only short-term relief. Once the disease became castration-resistant, the outlook worsened. Chemotherapy with docetaxel was the main treatment, but it only extended survival by a few months and caused harsh side effects. 

There was a clear need for better options. Abiraterone provided a new solution. In trials like COU-AA-301 and COU-AA-302, it improved survival for men with metastatic castration-resistant prostate cancer. It worked for both patients who had and hadn’t received chemotherapy. Abiraterone extended survival, delayed disease progression, and controlled symptoms. 

Many patients had a better quality of life than those on placebo. The results were promising. Abiraterone extended survival by months, with a relatively mild safety profile. It introduced a new approach, targeting androgen production beyond the testes. When combined with prednisone, it lowered the risk of death by 38%. 

Over time, abiraterone became a cornerstone of prostate cancer treatment. Its success led to the use of second-generation hormone therapies and sparked the development of drugs like Enzalutamide. 

Abiraterone proved castration-resistant prostate cancer wasn’t truly androgen-independent. With the right strategy, even stubborn tumors could be controlled.

How Abiraterone Is Absorbed and Metabolized

Abiraterone acetate is taken by mouth, but it doesn’t work in the body until it’s processed. After you swallow it, the drug gets turned into its active form—abiraterone—which is the part that blocks hormone production. One important thing to know is that abiraterone is absorbed much better when taken with food, especially high-fat meals. But that’s not a good thing here. 

If you take it with food, it can cause a big spike in drug levels, which can lead to side effects. That’s why it’s prescribed to be taken on an empty stomach, at least two hours after a meal and one hour before the next one.

Once abiraterone gets into the bloodstream, the liver plays a major role in breaking it down. Two enzymes CYP3A4 and SULT2A1 help turn it into forms that the body can remove through bile and feces. The drug stays active in the body for about 12 hours, which is why it’s taken once a day.

Because the liver does most of the work here, doctors have to be careful with patients who have liver problems. If the liver can’t clear the drug well, abiraterone can build up in the body and cause harm. That’s why liver function is checked regularly during treatment, and the dose may be adjusted if needed.

Long-Term Survival with Abiraterone in Newly Diagnosed mCSPC

Abiraterone was first used for advanced prostate cancer that no longer responded to hormone therapy. 

Now, it’s being used earlier, especially in men with metastatic castration-sensitive prostate cancer (mCSPC), where the cancer has spread but still reacts to lowering testosterone.

The LATITUDE trial showed how much of a difference this could make. Men who got abiraterone with ADT (androgen deprivation therapy) lived longer than those who got ADT with placebo. The abiraterone group had a median overall survival of 53.3 months, compared to 36.5 months in the placebo group. That’s close to 17 months more. Other major studies added to this. In the COU-AA-302 trial, men with metastatic castration-resistant prostate cancer (mCRPC) who hadn’t had chemotherapy yet lived a median of 35.3 months on abiraterone, compared to 30.1 months with placebo.

In the COU-AA-301 trial, which focused on men who had already received chemotherapy, survival went from 11.2 months with placebo to 15.8 months with abiraterone. Even at that stage, the drug gave patients more time. In real-world use, results were just as strong. Men who got abiraterone as their first treatment for mCRPC had a median survival of 42.1 months, and 74% were still alive after 2 years.

The treatment order also mattered. Patients who got ARAT therapy like abiraterone followed by chemotherapy had a median survival of 38.8 months. For those treated with only ARAT therapy, median survival hadn’t been reached yet at the time of analysis, meaning many were still living past the study’s endpoint.

All of this shows how abiraterone has changed what long-term care looks like for advanced prostate cancer. 

Whether used early with ADT in mCSPC or later in mCRPC, the drug reliably adds months, and often years to survival. It also helps push back the need for more aggressive treatment like chemotherapy.

Real-World Impact on Patients

Beyond the trials and data, here’s how patients have actually responded to abiraterone.

Case Study 1: Rob Lester’s Second Chance at Life After Prostate Cancer

• Background: Rob, a 55-year-old GP with no family history of prostate cancer, was blindsided by a late-stage diagnosis that had already spread to his bones, forcing him into early retirement and the painful thought that he might only have five years left.

• Search for a Cure and Clinical Trial: Offered a place on the STAMPEDE trial, Rob began taking abiraterone, a breakthrough drug developed through ICR’s research. It felt like winning the lottery. The treatment worked quickly, lowering his testosterone and PSA levels without the need for chemotherapy.

• Long-Term Outcome and Financial Impact: Eight years later, Rob is still going strong. He’s fitter than he’s been in decades, traveling the world with his wife, leading community music sessions, and enjoying every day, proof that smart, targeted treatments can give patients not just more time, but a better life.

Case Study 2: Drew’s 22-Year Battle with Metastatic Prostate Cancer

• Diagnosis and Early Challenge: Diagnosed at 45 with metastatic prostate cancer and given a grim prognosis, Drew was told to expect just two years. Despite the overwhelming odds, he took a proactive stance and began exploring every treatment option available.

• Innovative Treatments and Clinical Trials: Drew’s involvement in multiple clinical trials gave him access to emerging therapies, including abiraterone and Provenge, which helped control his cancer and led to the adoption of these treatments in the standard care protocol for metastatic prostate cancer.

• Defying Expectations and Long-Term Success: Now 22 years into his diagnosis, Drew’s cancer remains stable, and he continues to live a full life. His perseverance, alongside his contributions to clinical trials, has shaped both his personal journey and the broader landscape of cancer treatment.

What Happens If Abiraterone Stops Working?

If abiraterone stops working, it usually means the cancer has become resistant or is progressing. When this happens, doctors turn to other treatments:

• Enzalutamide: Another androgen receptor blocker, used when abiraterone no longer works. It targets the androgen receptor more directly. In terms of effectiveness, Abiraterone vs Enzalutamide is quite close.

• Chemotherapy: Medications like docetaxel are used when hormone treatments fail. Chemotherapy targets the cancer cells more broadly but comes with side effects.

• Radionuclide Therapy (Radium-223): This treatment delivers radiation to cancer cells in the bones, easing pain and slowing the spread of cancer.

• Immunotherapy: Not in full practice yet. While still being studied for prostate cancer, treatments like sipuleucel-T or checkpoint inhibitors (like pembrolizumab) are being tested to help the immune system target and destroy cancer cells.

Financial Burdens of Brand Name Abiraterone

The cost of Zytiga and its generics can be a serious barrier, especially for patients facing high co-pays or lacking strong insurance coverage. Many support programs exist to ease this burden:

• Janssen CarePath (Zytiga): Offers financial help through the Zytiga Patient Assistance Program and co-pay support for those with commercial insurance.

• Apotex Savings Program: Supports patients using generic abiraterone with the Apotex Instant Savings Card, reducing out-of-pocket costs for eligible commercially insured patients.

• Amneal Pharmaceuticals Program: Provides cost relief for generic abiraterone through the Amneal Copay Card, helping patients with private insurance manage expenses.

• PAN Foundation: Assists insured patients with prostate cancer in covering abiraterone-related out-of-pocket costs.

• HealthWell Foundation: Offers grants for patients needing financial help specifically with abiraterone when insurance doesn’t cover the full cost.
   

These programs improve access to abiraterone by directly supporting patients with the financial demands of ongoing treatment.

Zytiga vs. Generic Abiraterone: Cost & Access Today

Zytiga is pricey, which limits access, but generic abiraterone such as Abirapro by Glenmark offers a more affordable option with the same effectiveness.

• Brand Name Abiraterone: In the U.S., Abiraterone costs around $10,000 per month. In India, it's about $200, and in the U.K., private patients pay roughly $3,400. 

• Generic Abiraterone: Medicare Part D now covers 100% of the 250-mg generic and 79% of the 500-mg version. Patients can find a year’s supply of the 250-mg generic for about $1,100, a fraction of the brand-name price.

It is almost high price in other countries as well. As we can see the big difference in Abiraterone price in US, UK, Philippines, Malaysia vs India.

Abiraterone's Role in Shaping Modern Cancer Treatment

Abiraterone helped move prostate cancer treatment toward more targeted hormone therapy. Its ability to block the androgen pathway made it a key option when broader treatments fell short. The results opened the door for drugs like enzalutamide and encouraged more work on hormone-driven cancers beyond the prostate.

What We Do To Help

At Medixo Centre, we aim to provide generic abiraterone available to those who need it. If the cost is too high, get in touch with us. We’ll do our best to help you access the treatment you need.