Why Are Corticosteroids Used for Prostate Cancer Treatment?

• Corticosteroids can help lower testosterone levels in men living with prostate cancer.

• Corticosteroids may cause bothersome symptoms like insomnia, weight gain, and weakened bones.

Corticosteroids — often simply called steroids — treat many health conditions. In fact, they’re some of the most common medications available.

Depending on the purpose, corticosteroids can be used for a short or long period of time. They can treat a temporary chest infection. Or they could be used over time for conditions like rheumatoid arthritis (RA). This is usually because of their anti-inflammatory effects. Inflammation can cause or worsen many health conditions.

Corticosteroids are also used frequently to treat people living with prostate cancer. In addition to anti-inflammatory effects, they’re helpful because they can help lower testosterone levels, they can control pain, and they may be useful to help reduce side effects of prostate cancer medications. These properties are crucial for treating many cases of prostate cancer.

Here, we’ll talk about prostate cancer and corticosteroids — why they’re used, which ones are common, and side effects to be aware of.

Why are corticosteroids used to treat prostate cancer?

Testosterone is a hormone that can act as a source of fuel for prostate cancer. It can help the cancer grow and spread. Testosterone is mostly made in the testicles, but your adrenal glands also make some, too. Your body has two adrenal glands, and they live on top of the kidneys.

Hormone therapy medications are often used as a go-to option to treat prostate cancer. This is because they can lower the amount of testosterone in the body. Lowering the amount of testosterone is a key treatment goal. Doing so often helps stop or slow the cancer from growing (worsening). Medications like leuprolide (Eligard, Lupron Depot), degarelix (Firmagon), and abiraterone (Zytiga) are all used for this purpose.

But most hormone therapy medications don’t stop the adrenal glands from making testosterone. They only focus on the testicles. The adrenal glands still make small amounts of testosterone. Another treatment may be needed to better limit prostate cancer’s source of fuel.

This is where corticosteroids come in. By further lowering testosterone levels, they can help slow down the cancer’s growth. Corticosteroids can also help control side effects of certain treatments, such as high blood pressure or changes in potassium levels. Abiraterone (Zytiga), another hormone therapy medication, is one of these treatments.

For example, abiraterone helps treat prostate cancer. But it also reduces the body’s ability to make steroids. Prednisone — a type of steroid medication — is commonly given to replenish steroids in the body. This helps reduce side effects like high blood pressure and low potassium.

For prostate cancer, corticosteroids are typically used at the same time as chemotherapy and/or hormone therapy to reduce side effects like nausea, allergic reactions, and fluid retention. Although corticosteroids are used often, they are not the first-choice option to lower testosterone. Experts consider them a "secondary" hormone therapy. 

But corticosteroids are still sometimes given by themselves to relieve pain, to treat bone symptoms, and for appetite stimulation. For example, they may be taken if someone’s cancer is no longer responding to chemotherapy. In these cases, they can help control bothersome symptoms caused by advanced cancer.

Your cancer specialist can tell you if and when you may need to use a corticosteroid.

What are the 4 corticosteroids often used for prostate cancer?

Four corticosteroids are recommended by the National Comprehensive Cancer Network (NCCN). For each of the medications listed, specific doses can vary. These include:

• Dexamethasone: This medication is usually taken by mouth or given as an infusion into a vein. It’s often used with abiraterone. It’s also given on the same day as chemotherapy infusions.

• Prednisone: This is an oral medication that’s also a common prostate cancer treatment. It’s used in similar situations as dexamethasone. It’s a daily medication that can be given alongside abiraterone and/or chemotherapy.

• Methylprednisolone: Methylprednisolone is used less frequently than dexamethasone and prednisone. It’s a twice daily medication that’s used with a specific version of abiraterone called Yonsa.

• Hydrocortisone: Hydrocortisone, like methylprednisolone, is less common in prostate cancer. It’s recommended to be used in combination with ketoconazole. This combination is rarely used for people with castration-resistant prostate cancer (CRPC). CRPC is a type of prostate cancer that doesn’t respond well to hormone therapy treatments.

But your cancer specialist may give you a corticosteroid for a different purpose aside from what’s mentioned above. They may decide that a different option or combination may be better for you.

What other medications are corticosteroids?

Aside from the four medications mentioned above, other corticosteroids are also available. Although they’re not recommended for prostate cancer, other common corticosteroids include:

• Budesonide: This is an inhaled medication usually used to treat asthma or COPD. It’s also available as an oral capsule used to treat Crohn’s disease. 

• Clobetasol: This is a topical medicine applied to the skin. It comes in many forms, such as a cream, lotion, and shampoo. It treats many skin conditions.

• Cortisone: This is an oral tablet that can be used to treat a variety of health conditions. It’s different from Cortizone, a brand-name version of hydrocortisone.

• Fluticasone: This medication comes as a nasal spray, inhaler, and cream. Depending on the formulation, it can treat conditions like allergies, asthma, or COPD.

• Prednisolone: This is a chemically active version of prednisone. It’s available as an eye drop, oral medication, and infusion that’s given into a vein. It can treat several health conditions.

• Triamcinolone: This is a medication that’s available as a cream, nasal spray, and injection. It treats many health conditions.

Which corticosteroid is the most effective for prostate cancer?

There isn’t one corticosteroid that’s generally the most effective. They’re each helpful in different situations. The “best” one for you depends on how advanced your cancer is and other medications you’re receiving.

But, dexamethasone and prednisone tend to be the most common choices.

What are side effects of taking corticosteroids?

Corticosteroids can offer benefits for people living with prostate cancer. But, like with all medications, they may cause side effects.

Side effects vary for every person. Specific side effects differ depending on the medication and dose you’re receiving. Side effects are also variable depending on if you take them for a short or long period of time. A short period of time is considered to be about 30 days or less.

But when corticosteroids are given to help treat prostate cancer, they’re usually given over a long period of time. This can range from months to years. Common long-term side effects of corticosteroids may include:

• Acne

• Weight gain

• Trouble sleeping

• Weaker bones (osteoporosis) and a higher fracture risk

• Weaker immune system

• Elevated blood pressure

• Heartburn and stomach ulcers

• Thin skin and easy bruising

Certain groups of people may also be more likely to experience side effects from corticosteroids. You’re more likely to experience bothersome side effects if you’re an older adult, have other health conditions, or take other medications that can weaken the immune system. 

To learn more about long-term side effects of corticosteroids, click or tap here.

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Written by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Sonja Jacobsen, PharmD, BCPS, BCOP

Sonja Jacobsen, PharmD, BCPS, BCOP,  is a clinical oncology pharmacy specialist currently practicing in Seattle. She has been practicing as a pharmacist since 2015 and is licensed to practice in Washington state and North Carolina.

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