ARPIs and Prednisone Use in Patients with Comorbidities in mCSPC

Panelists discuss how the requirement for prednisone coadministration with abiraterone influences tolerability, particularly in patients with preexisting cardiometabolic risk. Because prednisone helps suppress adrenal androgen production and reduce mineralocorticoid-related adverse effects, it is essential for abiraterone’s mechanism—but it also introduces its own metabolic and cardiovascular considerations. Patients with hypertension, diabetes, or heart disease face higher risks of elevated blood pressure, weight gain, glucose intolerance, and fluid retention, making close monitoring vital from therapy initiation onward.

Panelists discuss how clinicians mitigate these risks through proactive care. Before starting a patient on abiraterone, primary care or cardio-oncology specialists often optimize the patient’s blood pressure, lipid levels, and diabetes management. Once therapy begins, frequent laboratory assessments and vital-sign checks help detect early changes, allowing clinicians to adjust steroid dosing or supportive medications as needed. In contrast, androgen receptor pathway inhibitors (ARPIs), such as apalutamide or enzalutamide, do not require daily steroids, which may simplify management for patients with cardiometabolic comorbidities—but these agents still require monitoring for fatigue, falls, and potential cognitive effects.

Panelists discuss how therapy selection ultimately balances medical safety with patient preference. By individualizing treatment—considering comorbidities, lifestyle, and willingness to adhere to laboratory follow-up—clinicians can maximize benefit while minimizing harm. Clear education about prednisone’s purpose and potential effects empowers patients to participate actively in their care, ensuring that whichever ARPI is chosen fits both their disease and their daily life.