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Complete androgen blockade for prostate cancer: what went wrong?
M Laufer1, S R Denmeade, V J Sinibaldi
1Departments of Oncology and Urology, Johns Hopkins University, Baltimore, Maryland, USA.
The Journal of Urology
|June 7, 2000
Summary
Complete androgen blockade, which adds antiandrogens to castration, offers limited benefit for metastatic prostate cancer. This approach may also increase toxicity and reduce quality of life.
Area of Science:
- Oncology
- Urology
Background:
- Prostate cancer treatment often involves androgen deprivation therapy.
- Complete androgen blockade (CAB) aims to maximize androgen suppression.
- The efficacy and safety of CAB compared to standard castration require critical evaluation.
Purpose of the Study:
- To critically assess phase III clinical trial data comparing CAB to standard castration.
- To evaluate quality of life and toxicity associated with CAB.
Main Methods:
- Systematic review of published phase III clinical trials and meta-analyses.
- Analysis of data on treatment efficacy, toxicity, and quality of life.
Main Results:
- Out of 27 trials, only 3 showed a statistically significant benefit for CAB.
- Available data suggest higher toxicity and decreased quality of life with CAB.
- Toxicity and quality of life were not prospectively investigated in most studies.
Conclusions:
- Extensive data do not support the routine use of CAB as first-line therapy for metastatic prostate cancer.
- The addition of antiandrogens to standard castration is not routinely recommended.