Non-steroidal anti-androgens in prostate cancer--current treatment practice

Adenocarcinoma of the prostate is a common disease that causes significant morbidity and mortality in the adult male population. Hormonal therapy for prostate cancer is considered when a patient fails with initial curative therapy, such as radical prostatectomy or definitive radiation therapy, or if he is found with an advanced disease. Many hormonal agents have been developed to exploit the fact that prostate cancer growth is dependent on androgen. Non-steroidal anti-androgens (NSAAs) block androgen at the cellular level. Numerous clinical trials comparing monotherapy of castration and combination therapy of castration and NSAAs have been performed. At present, the results of the trials with regard to the survival of patients under therapy are conflicting. When the disease recurs in a patient in the middle of combination androgen blockade therapy, androgen withdrawal should be considered. The benefits of NSAA in monotherapy, intermittent or neoadjuvant therapy are not clear at present. Better designed, larger cohort clinical trial may be necessary to clarify the confusion.