Combined androgen blockade: an update

The use of combined androgen blockade therapy in prostate cancer management remains controversial. This article reviews the effect of the different non-steroid androgens in blocking androgen-independent activation of the androgen receptor in the androgen-depleted environment, and the potential benefit of bicalutamide in comparison to the first generation of anti-androgens (flutamide and nilutamide). An estimate of the benefit of combined therapy with bicalutamide suggests there is a high probability that bicalutamide 50 mg as combined therapy provides a survival advantage over castration alone. This treatment must be balanced against the potential for an increase in side-effects and a consequent adverse effect on the patient's quality of life.