Role of Corticosteroids in Prostate Cancer Treatment

Introduction to Corticosteroid Use

The National Comprehensive Cancer Network recommends prednisone 10 mg orally daily throughout treatment with docetaxel in both castration-sensitive prostate cancer (CSPC) and castration-resistant prostate cancer (CRPC), based on the landmark TAX 327 trial 1, 2
The American College of Physicians and other guideline societies support the use of prednisone 10 mg daily with docetaxel, demonstrating a median overall survival of 18.9 months versus 16.5 months with mitoxantrone (HR 0.79, p=0.009) 1, 3

The standard corticosteroid dose for docetaxel chemotherapy in CSPC and CRPC is prednisone 10 mg orally daily, with a demonstrated median overall survival of 18.9 months versus 16.5 months with mitoxantrone (HR 0.79, p=0.009) 1, 3
Alternative biweekly dosing of docetaxel 50 mg/m² every 2 weeks with prednisone 10 mg daily showed improved survival (19.5 vs 17.0 months, p=0.015) and better tolerability with reduced febrile neutropenia (4% vs 14%) compared to the 3-weekly schedule 1, 3

The FDA-approved regimen for cabazitaxel in mCRPC includes prednisone or prednisolone 10 mg orally daily throughout treatment, which is mandatory and not optional 3, 4
The recommended dose for most patients is cabazitaxel 20 mg/m² IV every 3 weeks with daily prednisone/prednisolone 10 mg, based on the PROSELICA trial demonstrating non-inferiority to 25 mg/m² with improved safety (median OS 13.4 vs 14.5 months, HR 1.024) 4

In castration-sensitive prostate cancer (CSPC), docetaxel with prednisone 10 mg daily is used upfront with ADT in high-volume or high-risk metastatic disease, not cabazitaxel 1
In castration-resistant prostate cancer (CRPC), docetaxel 75 mg/m² every 3 weeks (or 50 mg/m² every 2 weeks) with prednisone 10 mg daily is the Category 1 preferred option for docetaxel-naïve mCRPC 1, 3
After progression on both docetaxel and a novel hormone therapy, cabazitaxel demonstrates superior outcomes compared to switching to an alternative hormone therapy (rPFS 8.0 vs 3.7 months, HR 0.54, p<0.0001) 4