Maximum androgen blockade: a clinical update

Maximal androgen blockade (MAB) therapy for metastatic prostate cancer has advanced in recent years with the discovery of luteinizing hormone-releasing hormone agonists (LHRH), the development of LHRH analogues, and the discovery of antiandrogens. Of 36 studies of MAB therapy performed from 1980 to 1991, 3 showed a statistically significant increase in survival with MAB versus castration alone. Because of the large number of studies showing no benefit from MAB, a meta-analysis was performed on 27 studies. This meta-analysis demonstrated a survival benefit from MAB of only 3%; however, a critical review of the analysis revealed major flaws that raise serious questions regarding the validity of its findings. In addition, the fact remains that the longest survival reported for patients with stage M1 prostate cancer was 35 to 36 months, whereas the longest survival for castration alone was 32 to 33 months. Therefore, when physicians discuss treatment choices for patients with metastatic disease, MAB should remain a reasonable option.