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Maximal androgen blockade for advanced prostate cancer.
B Schmitt1, C Bennett, J Seidenfeld
1Health Services Research & Development Program, VA Chicago Health Care System-Lakeside Division, 333 E. Huron Street, Chicago, Illinois 60611, USA. Cbenne@nwu.edu
The Cochrane Database of Systematic Reviews
|May 5, 2000
Summary
Maximal androgen blockade (MAB) offers modest survival benefits at five years for advanced prostate cancer but increases adverse events. Castration alone may improve quality of life in the short term.
Area of Science:
- Oncology
- Clinical Trials
- Prostate Cancer Research
Background:
- Advanced prostate cancer treatment often involves reducing androgen levels.
- Maximal androgen blockade (MAB) combines castration with non-steroidal anti-androgens (NSAAs).
- The comparative efficacy and safety of MAB versus castration alone remain subjects of investigation.
Purpose of the Study:
- To systematically review and compare the effects of MAB versus castration alone on survival outcomes in advanced prostate cancer.
- To evaluate progression-free survival, cancer-specific survival, and adverse events associated with MAB.
- To assess the impact on quality of life.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) from multiple databases.
- Inclusion criteria: RCTs comparing MAB to castration alone in advanced prostate cancer patients.
- Outcomes assessed: overall survival, progression-free survival, cancer-specific survival, and adverse events.
Main Results:
- Twenty trials with 6,320 patients were analyzed.
- MAB showed a modest, statistically significant improvement in overall survival at 5 years (OR=1.29).
- Increased adverse events and reduced quality of life were observed with MAB.
Conclusions:
- Maximal androgen blockade provides a modest survival benefit at 5 years for advanced prostate cancer.
- The benefits are counterbalanced by a higher incidence of adverse events and diminished quality of life.
- Further research may explore optimizing MAB or identifying patient subgroups who benefit most.