CAB (like Zoladex/Lucrin and Cosudex) choice for advanced PCa

[JimmyToowong]

Clin Genitourin Cancer. 2007 Sep;5(6):371-8.

Combined androgen blockade in advanced prostate cancer: looking back to move forward.

Chodak G, Gomella L, Phung de H.

Midwest Prostate and Urology Health Center, Weiss Memorial Hospital, Chicago, IL 60640, and Department of Urology, Jefferson Medical College, Philadelphia, PA, USA. gchodak1@aol.com

Abstract

In 1989, Crawford and colleagues suggested that combined androgen blockade with castration plus antiandrogen therapy provided significantly improved survival compared with castration alone. Since then, some studies have supported these results, whereas others have not. To resolve this discrepancy, the Prostate Cancer Trialists' Collaborative Group conducted a metaanalysis of 27 randomized trials to evaluate whether combined androgen blockade has benefits compared with castration alone. The results published in 2000 showed that combined androgen blockade using a nonsteroidal antiandrogen treatment (nilutamide or flutamide) improved survival compared with castration alone, whereas combined androgen blockade using a steroidal antiandrogen agent (cyproterone acetate) reduced survival compared with castration alone. In 2004, an analysis was carried out to evaluate the nonsteroidal antiandrogen agent bicalutamide in the combined androgen blockade setting, by incorporating the data from a trial of combined androgen blockade with bicalutamide versus combined androgen blockade with flutamide with the Prostate Cancer Trialists' Collaborative Group metaanalysis data for combined androgen blockade with flutamide versus castration. This analysis showed that combined androgen blockade with bicalutamide was associated with a 20% reduction in the risk of death compared with castration alone. The survival benefit associated with combined androgen blockade using a nonsteroidal antiandrogen agent should be weighed against the potential for increased toxicity and expense compared with castration alone. Studies have shown that bicalutamide has a better tolerability profile than flutamide or nilutamide. Furthermore, cost-benefit analyses of combined androgen blockade with bicalutamide suggest it is a cost-effective option versus castration alone and versus combined androgen blockade with flutamide. In summary, the present evidence suggests that combined androgen blockade with a nonsteroidal antiandrogen agent should be a first-line therapy option in patients with advanced disease.

PMID: 17956709 Forum: Very high risk Title: CAB choice for advanced PCa

My translation:

If you have advanced disease, the authors are suggesting:

Cut the testosterone from the testes by castration - physically (with a scalpel) of by drugs (implant such as Zoladex or Lucrin).

Cut the testosterone from the adrenal glands by using Cosudex (bicalutamide).

Don't use a steroidal antiandrogen (like Androcur (cyproterone acetate)) to do this - [jm: it has been reported in a paper by different authors that the long-term use of Androcur in this combination that has been reported as a problem. Use for just a few weeks at the beginning of Zoladex, Lucrin etc. to prevent flare has not been shown to cause problems.)

This extract can be found on http://PubMed.com, and is in the public domain.

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Any highlighting (except the title) is not by the author, but by Jim Marshall.

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