[Monotherapy versus combined androgen blockade for advanced/metastatic prostate cancer]

In advanced/metastatic prostate cancer, a standard treatment is androgen deprivation therapy, either by surgical castration/LH-RH agonist monotherapy or by combined androgen blockade (CAB) with an antiandrogen. Clinical improvement and survival after CAB with an antiandrogen (instead of monotherapy) has been investigated for 20 years in many randomized clinical trials conducted primarily in Europe and America. However, there were both positive and negative results regarding the efficacy of CAB therapy. Therefore, CAB has neither been recommended as, nor has it become, a common therapy. But, in 2000, a meta-analysis-conducted Prostate Cancer Trialists Collaborative Group (PCTCG)showed the survival benefits of CAB with nonsteroidal antiandrogen (nilutamide and flutamide). Moreover, the J-Cap phase III trial in Japan suggested that CAB with bicalutamide significantly prolongs survival, which has led to the placement of CAB as the treatment of choice for advanced/metastatic prostate cancer. Neverthless, the benefit of CAB compared to monotherapy remains controversial because of the many issues involving survival, safety profiles, QOL, and cost-effectiveness. In this article, we discuss the feasibility of CAB for advanced/metastatic prostate cancer by reviewing the results of RCT, and introduce novel treatment modalities involving androgen and the androgen receptor, which are still under development.