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Total androgen ablation: Canadian experience.

G Béland1, M Elhilali, Y Fradet

  • 1University of Montréal Medical School, Québec, Canada.

The Urologic Clinics of North America
|February 1, 1991
PubMed
Summary
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Total androgen blockade using nilutamide and castration showed improved bone pain response and favorable responses in prostate cancer patients compared to simple castration. However, no significant differences in progression or survival were observed.

Area of Science:

  • Oncology
  • Urology

Background:

  • Prostate cancer treatment often involves androgen deprivation therapy.
  • The efficacy of total androgen blockade versus simple castration is an area of ongoing research.

Purpose of the Study:

  • To compare the efficacy of total androgen blockade (castration plus nilutamide) with simple castration in treating advanced prostate cancer.

Main Methods:

  • A multicenter, randomized, double-blind trial was conducted.
  • 105 patients received combined treatment (castration + nilutamide), and 103 received simple castration (orchiectomy + placebo).
  • Efficacy was evaluated using bone pain response, NPCP criteria, time to progression, and survival rates.

Main Results:

  • Combined treatment showed better bone pain response at 6 months (P=0.042) and a higher number of favorable responses by NPCP criteria (78% vs. 61%, P=0.013).

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  • No statistically significant differences were found in time to progression (P=0.462) or survival (P=0.137).
  • Median survival increased by 5.4 months with combined treatment, but overall survival and progression rates at 1-2 years showed no significant benefit.

    • Conclusions:

    • Total androgen blockade offers some benefits in symptom control (bone pain) and objective response rates for prostate cancer.
    • However, it does not significantly improve time to progression or overall survival compared to simple castration.
    • Current evidence suggests limited or modest benefits of total androgen blockade over testicular androgen ablation alone.