Incorporating Micronized Abiraterone and Low-Fat Meal Dosing: Monitoring Efficacy and Tolerability

EP: 1.A 74-Year-Old Man With Metastatic Castration-Resistant Prostate Cancer (mCRPC)

EP: 2.Assessing Tolerability and Clinical Considerations in Abiraterone Formulation Selection

EP: 3.Formulation Matters: Tailoring Abiraterone Dosing for Optimal Absorption and Tolerability

EP: 4.The Impact of Comorbidities, Adherence, and Access on mCRPC Treatment Decisions

EP: 5.A 62-Year-Old Man With High-Risk Localized Prostate Cancer

EP: 6.The Role of Genomic Classifiers in Guiding Therapy for Localized High-Risk Prostate Cancer

EP: 7.Decision-Making and Multidisciplinary Counseling for Nodal Involvement on PSMA PET

EP: 8.Managing Abiraterone Intolerance: Alternative Dosing Strategies in Practice

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EP: 9.Incorporating Micronized Abiraterone and Low-Fat Meal Dosing: Monitoring Efficacy and Tolerability

EP: 10.Approaching Corticosteroid Selection With Abiraterone in Patients With High-Risk Localized or Locally Advanced Prostate Cancer

EP: 11.Considering Therapy De-Intensification: Balancing Adverse Effects and PSA Response

Managing Abiraterone Tolerability Issues

This segment addresses practical solutions for patients experiencing difficulty with traditional abiraterone fasting requirements, focusing on evidence-based alternatives to maintain treatment efficacy. When patients cannot adhere to the strict fasting protocol required for standard abiraterone formulation, clinicians have 2 primary options: microsized abiraterone that can be taken with food, or off-label dosing with a single 250-mg tablet taken with a low-fat breakfast.

The microsized formulation represents the preferred on-label alternative, offering improved tolerability through food flexibility while maintaining established efficacy and safety profiles. The off-label low-fat breakfast approach, although supported by clinical trial data, presents practical challenges in patient education and adherence. Many patients struggle with the concept of consistently preparing and consuming truly low-fat meals, particularly in populations with established dietary habits that may not align with nutritional recommendations.

Patient education becomes crucial regardless of the chosen alternative, requiring clear explanation of dietary requirements and close monitoring of laboratory values including electrolytes, liver function, prostate-specific antigen, and testosterone levels. The segment emphasizes that successful outcomes depend not only on appropriate formulation selection but also on realistic assessment of patient ability to maintain long-term adherence with any given regimen.