Continued from PROSTATE CANCER: LATE STAGE
The Treatment of AIPC
Nizoral or High-dose Ketoconazole (HDK) with Hydrocortisone (HC)
Nizoral plus hydrocortisone (HC) is an excellent treatment approach for men with AIPC. In fact, Nizoral has so many outstanding effects against both ADPC and AIPC that it is surprising not to see this agent as a mainstay in the initial treatment of PC. Nizoral rapidly lowers serum testosterone to castrate levels by 48 hours by mechanisms that are different than LHRH agonists and antiandrogens (see figure below after Trachtenberg et al.).
After Trachtenberg, et al. (J. Urol., 1983)
Nizoral blocks the production of testosterone produced by the testicles and blocks the production of androgen precursors (DHEA, DHEA-S, and androstenedione) that are metabolized to T and DHT within the prostate cell. Since Nizoral also may reduce cortisol production by approximately 25%, a small percentage of patients may develop symptoms consistent with adrenal mineralocorticoid deficiency. Patients therefore are usually given HC (hydrocortisone) along with Nizoral to prevent this potential side effect and also because of the known antitumor effect of HC against AIPC. The standard dose of HC advised is 20 mg with breakfast and 20 mg with dinner. Patients may have their dose of HC titrated down using the results of ACTH and cortisol levels.
Continuation of PROSTATE CANCER: LATE STAGE