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Flutamide + Finasteride for recurrence


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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.


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



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.


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.


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.


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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