Caution – The FDA Has Limited The Usage of Nizoral (ketoconazole)

Nizoral (ketoconazole, keto) is an older drug that has been used as a part of hormone therapy (ADT) for many years.  Keto, which is an inexpensive anti-fungal drug had been used for many years as an inhibitor of adrenal androgen synthesis as is abiriterone (Zytiga). Ztiga has been shown to be more effective, however, it [...]

A Surprising Biochemical Response to Ketoconazole In Post-Chemotherapy mCRPC Men When Compared to the Zytiga Trial Results

It has always been assumed that Ketoconazole, when used for the treatment of men with metastatic castration resistant prostate cancer (mCRPC), would not be as potent as abiraterone (Zytiga), but there has never been any head to head comparison to demonstrate this assumption! Ketoconazole is a less potent inhibitor of the CYP-17 enzyme, the mode [...]

Can Zytiga Be Used In Men Previously Treated With Ketoconazole: A Prospective Phase II Study

Some men with advanced prostate cancer have been given the antifungal treatment Ketoconazole (Keto) as a second line hormone treatment. Like Keto, this newer hormone treatment that is now available, Abiraterone acetate (AA) (Zytiga) works by inhibiting CYP17, the rate-limiting enzyme in androgen biosynthesis. The question being asked, if Keto has failed ,given its similar [...]

The Differences in Ketoconazole & Abiraterone (Zytiga)

Zytiga  (abiraterone acetate) and Ketoconazole (keto) are both widely used in prostate cancer therapy to treat men with advanced prostate cancer.   They both have a common mechanism of action, they both work by inhibiting the enzyme CYP17 that is responsible for androgen biosynthesis (creation).  Inhibiting CYP17 lowers testosterone levels, which results in prostate cancer tumor regression. Because [...]

No Difference In Ketoconazole Response For Men With Advanced Prostate Cancer Post Chemotherapy Failure

The use of Ketoconazole (Keto) in men with advanced prostate cancer is not considered mainstream, however there is clear evidence that it does reduce PSA in men with castrate resistant prostate cancer. Currently, most men with advanced prostate cancer who do use Keto utilize it prior to chemotherapy. There has been little literature evaluating the [...]

More About Dosing Ketoconazole

There are two different dosage levels used for the administration of Ketoconazole (Keto), a commonly used 2nd line hormone deprivation drug used after the failure of the traditional drugs (Lupron, Zoladex etc.). Low dosage keto involves taking 200 mg three times a day (600 mg per day), while high dose keto uses 400 three times [...]

Ketoconazole – How To Take It So That It Works

Recently, I received two separate questions about both low dose ketoconazole (LDK) and high dose ketoconacole (HDK). For both of these men with castrate resistant advanced prostate cancer, their PSA scores continued to rise, despite their using keto. Even when taken properly, not all men experience a positive effect from the drug (a decline in [...]

Ketoconazole – A Second Line Hormone Therapy (Part 1 of a Series of Posts on Second Line Hormone Therapy)

At some point in the progression of advanced prostate cancer the usual initial standard of care, hormone therapy (ADT2 or ADT3), will fail to control the progression of the cancer. Commonly, when ADT does fail we will experience an increase in our PSA scores and often see signs of disease progression on imaging tests. For [...]

The Question, When to Use A Treatment & What Drugs Should Be Combined?

The approval of Provenge has once again brought to the forefront the very important questions about the proper timing of treatments as well as the issue concerning how to combine therapies to maximize survival. We have, although there numbers are limited, different treatments that are used for the treatment of advanced prostate cancer, but we [...]

Ketoconazole- A Secondary Hormone Manipulation

Ketoconazole (kee-ta-KOE-na-zol), generic name for Nizoral, is an oral drug approved by the FDA for the use to treat fungal infections. However, it has been shown that higher doses of ketoconazole (800-1200mg/day vs 200-400mg/day) also block the production of both free and bound testosterone. Since high-dose Ketoconazole (HDK) has testosterone lowering effects, operating both on [...]