Case Presentation: In September 2021, a 53-year-old male with a BMI of 30.91 and no history of alcohol use was diagnosed with advanced prostate cancer, indicated by a PSA level of 111. A transrectal ultrasound-guided prostate biopsy revealed Gleason score 4+5 prostate adenocarcinoma. In February 2022, the patient initiated treatment with Androgen Deprivation Therapy (ADT) and radiation. Despite this, his testosterone levels failed to suppress adequately, leading to discontinuation of ADT. In March 2022, his treatment was escalated to include abiraterone and prednisone. However, in April 2022, initial Liver Function Tests (LFTs) revealed elevated levels (ALT 87, AST 41), suggesting liver toxicity likely induced by the new treatment. Consequently, abiraterone therapy was halted. The patient briefly resumed abiraterone and prednisone in late May for one week, but this therapy was again stopped due to further elevation in LFTs. In June 2022, the patient presented to the hospital with peak liver enzyme levels (ALT 456, AST 194) and right upper quadrant pain. The acute elevation in liver enzymes prompted a thorough evaluation. By July 2022, the liver enzyme pattern and clinical presentation pointed towards drug-induced liver injury (DILI), attributed to the use of abiraterone. Liver enzymes gradually declined after discontinuation of abiraterone, though levels remained elevated (ALT 225, AST 112). In April 2023, a liver biopsy confirmed the presence of steatohepatitis and macrovesicular steatosis.

Discussion: This case exemplifies a critical aspect of hospital medicine: managing complex pharmacological treatments in a dynamic inpatient setting. Abiraterone, a CYP17 inhibitor, has transformed the treatment landscape for metastatic castration-resistant prostate cancer and high-risk metastatic castration-sensitive prostate cancer. The patient’s acute hospital presentation in June with elevated liver enzymes following abiraterone therapy prompted an extensive, multi-disciplinary approach, typical of hospital medicine. This meticulous evaluation was crucial in the identification of DILI, leading to the discontinuation of abiraterone.

Conclusions: While abiraterone offers a promising treatment avenue for high-risk prostate cancer, its potential for serious side effects, such as liver dysfunction, calls for careful use. This case emphasizes the importance of heightened awareness and understanding of these side effects. It emphasizes the necessity of integrating regular liver function monitoring and proactive strategies within a patient-tailored approach. This scenario not only sheds light on abiraterone’s hepatotoxicity risks but also underscores the critical role of thorough clinical evaluation and multi-disciplinary care in patients navigating complex oncological therapies.