Abiraterone and Spironolactone in Prostate Cancer: A Combination to Avoid

The document from 2018 presents a case where an 86-year-old man with metastatic castration-resistant prostate cancer (mCRPC) experienced disease progression after being treated with abiraterone acetate and spironolactone. The increase in prostate-specific antigen (PSA) levels and the appearance of new bone metastases after the addition of spironolactone, followed by a decline in PSA levels upon its discontinuation, led to the conclusion that spironolactone may act as an androgen receptor agonist in an androgen-depleted environment, promoting cancer proliferation. Consequently, the document recommends against the use of spironolactone in mCRPC patients treated with abiraterone due to the potential for disease progression and suggests caution with other steroidal mineralocorticoid receptor antagonists. Alternative treatments such as eplerenone or amiloride (± hydrochlorothiazide) are proposed, with the caveat that eplerenone may interfere with abiraterone efficacy in certain cases. The study was supported by the Fund for Scientific Spearheads of Ghent University Hospital and the Flemish cancer society, with no conflicts of interest reported by the authors.