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Antiandrogenic substances in the management of prostatic cancer
1Department of Urology, Erasmus University, Rotterdam, The Netherlands.
Abstract:
Endocrine-active and pure antiandrogens have different mechanisms of action and different endocrinological effects in the intact male. With pure antiandrogens as a monotherapy an elevation of plasma testosterone occurs which probably leads to the preservation of potency, the clinical significance of which in the management of prostatic carcinoma is not known. Plasma testosterone is reduced to pretreatment levels after 12 months. Longer observations are not available. In total androgen suppression regimens both types of antiandrogens have been shown in prospective trials to be at least equally effective as standard treatment. The clinical effectiveness of CPA alone in prostatic cancer has been shown to be equal to that of DES 1 mg tid. Sufficiently large prospective studies on flutamide alone in comparison to standard treatment have not been carried out. The use of antiandrogens is recommended during the initial 4 weeks of management of prostatic carcinoma patients with LH-RH agonists to prevent disease flare-up and to achieve higher early response rates in selective patients.
Insights
Pure antiandrogens can elevate testosterone, potentially preserving potency in men. Both endocrine-active and pure antiandrogens are effective in total androgen suppression for prostate cancer management.
Area of Science:
- Endocrinology
- Oncology
- Pharmacology
Background:
- Endocrine-active and pure antiandrogens exhibit distinct mechanisms and effects.
- Understanding these differences is crucial for managing conditions like prostate carcinoma.
Purpose of the Study:
- To compare the effects and efficacy of different types of antiandrogens.
- To evaluate their role in prostate cancer treatment and management.
Main Methods:
- Review of prospective trials comparing antiandrogens with standard treatments.
- Analysis of endocrinological effects, including plasma testosterone levels and potency.
Main Results:
- Pure antiandrogens monotherapy may elevate plasma testosterone, potentially preserving potency, though long-term significance is unknown.
- Both antiandrogen types demonstrate equal efficacy to standard treatments in total androgen suppression regimens.
- Cyproterone acetate (CPA) monotherapy shows effectiveness comparable to diethylstilbestrol (DES) in prostate cancer.
Conclusions:
- Antiandrogens are effective in total androgen suppression for prostate cancer.
- Consideration of antiandrogens is recommended during initial LH-RH agonist therapy to prevent disease flare-up.
- Further large-scale prospective studies on flutamide monotherapy are needed.