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Flutamide + Finasteride for recurrence


JimJimJimJim

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JimJimJimJim

When PSA begins to rise after surgery or radiation, a combination of an antiandrogen (Flutamide) and a 5-alpha reductase inhibitor (Finasteride) gave good results. Without the full paper, we do not know about the details of the men - Gleason score, PSA, etc.

This would seem to be a very gentle treatment.

A more commonly used antiandrogen you may know of is Cosudex.

A more commonly used 5-alpha reductase inhibitor you may know is Avodart.

Antiandrogens include:

Cosudex/Casodex (bicalutamide), Anandron (Nilutamide), Nilandron(Nilutamide), Eulexin (Flutamide), all nonsteroidal, and Androcur (Cyproterone, a steroid), Nizoral (Ketoconazole), Zytiga (abiraterone acetate)

5-alpha reductase inhibitors include:

Avodart (dutasteride) which inhibits types I & II, Proscar (Finasteride), Propecia (Finasteride) which inhibits only type II

Cancer. 2011 Dec 16. doi: 10.1002/cncr.26732. [Epub ahead of print]

Efficacy of peripheral androgen blockade in prostate cancer patients with biochemical failure after definitive local therapy: Results of Cancer and Leukemia Group B (CALGB) 9782.

Monk JP, Halabi S, Picus J, Hussain A, Philips G, Kaplan E, Ahles T, Gu L, Vogelzang N, Kelly WK, Small EJ; for the Cancer and Leukemia Group B.

Source

Division of Oncology, Department of Medicine, The Ohio State University School of Medicine, Columbus, Ohio. Paul.monk@osumc.edu.

Abstract

BACKGROUND:

The treatment for prostate cancer patients with biochemical failure after local therapy remains controversial. Peripheral androgen blockade using a combination of a 5-alpha reductase inhibitor and an antiandrogen may allow control of the prostate-specific antigen (PSA). Because testosterone levels are not suppressed, this approach may be associated with less morbidity than conventional gonadal androgen suppression.

METHODS:

All patients had undergone previous definitive local therapy and had evidence of a rising PSA >1ng/mL, with no evidence of recurrent disease. Patients received both finasteride, 5 mg orally per day, and flutamide, 250 mg orally 3× a day. Patients were followed for a PSA response and quality of life assessment.

RESULTS:

Ninety-nine of 101 accrued patients were eligible. A ≥80% PSA decline was seen in 96 (96%) patients. The median time to PSA progression was 85 months. With a median follow-up of 10 years, the median survival time had not been reached, and the 5-year overall survival rate was 87%. Toxicity was mild, with 18 patients stopping for toxicity; 15 had diarrhea, 4 had gynecomastia, and 3 had transaminase elevation. Baseline Functional Assessment of Cancer Therapy Prostate Module and Treatment Outcome Index scores decreased by 5 points each at 6 months after enrollment.

CONCLUSIONS:

The use of the finasteride/flutamide combination is feasible, and results in PSA declines of ≥80% in 96% of patients with serologic progression after definitive local therapy. There were no unexpected toxicities, and the change in quality of life was mild. Further evaluation of this or a similar regimen in a controlled clinical trial is warranted. Cancer 2012;. © 2011 American Cancer Society.

Copyright © 2011 American Cancer Society.

PMID: 22180287

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