Association of Tissue Abiraterone Levels and Genotype with Intraprostatic Steroids and Pathologic Response in Men with High-Risk Localized Prostate Cancer.

Germline variation in solute carrier organic anion () genes influences cellular steroid uptake and is associated with prostate cancer outcomes. We hypothesized that, due to its steroidal structure, the CYP17A inhibitor abiraterone may undergo transport by -encoded transporters and that gene variation may influence intracellular abiraterone levels and outcomes. Steroid and abiraterone levels were measured in serum and tissue from 58 men with localized prostate cancer in a clinical trial of LHRH agonist plus abiraterone acetate plus prednisone for 24 weeks prior to prostatectomy. Germline DNA was genotyped for 13 SNPs in six genes. Abiraterone levels spanned a broad range (serum median 28 ng/mL, 108 nmol/L; tissue median 77 ng/mL, 271 nmol/L) and were correlated ( = 0.355, = 0.001). Levels correlated positively with steroids upstream of CYP17A (pregnenolone, progesterone), and inversely with steroids downstream of CYP17A (DHEA, AED, testosterone). Serum PSA and tumor volumes were higher in men with undetectable versus detectable tissue abiraterone at prostatectomy (median 0.10 vs. 0.03 ng/dL, = 0.02; 1.28 vs. 0.44 cc, = 0.09, respectively). SNPs in associated with significant differences in tissue abiraterone (rs1789693, = 0.0008; rs12422149, = 0.03) and higher rates of minimal residual disease (tumor volume < 0.5 cc; rs1789693, 67% vs. 27%, = 0.009; rs1077858, 46% vs. 0%, = 0.03). LNCaP cells expressing SLCO2B1 showed two- to fourfold higher abiraterone levels compared with vector controls ( < 0.05). Intraprostatic abiraterone levels and genetic variation in genes are associated with pathologic responses in high-risk localized prostate cancer. Variation in genes may serve as predictors of response to abiraterone treatment. .