Prostate Cancer — SCE Medical Oncology MCQ

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HardUrological CancersProstate CancerSCE Medical Oncology

A 70-year-old man with mCRPC on abiraterone develops mineralocorticoid-related side effects (oedema, hypertension, hypokalaemia). He is already on prednisolone 5 mg BD. What specific mineralocorticoid receptor antagonist can be added to manage these effects?

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Correct answer: D — Eplerenone

Eplerenone (selective MRA) is preferred over spironolactone for abiraterone-related mineralocorticoid excess because spironolactone has anti-androgen properties that could theoretically counteract the therapeutic effect of abiraterone. Eplerenone lacks anti-androgen activity. Increasing prednisolone dose is an alternative (better ACTH suppression reduces upstream mineralocorticoid precursors) but increases steroid side effects.

Reference: BNF Abiraterone and eplerenone monographs; ESMO 2024 Prostate Cancer Guidelines; Attard et al JCO 2008