Progress in complete androgen blockade

Complete androgen blockade (CAB) has been shown to increase the survival of patients with symptomatic advanced prostate cancer in three large well-conducted trials compared with castration alone. However, several smaller trials found no survival advantage with CAB. A recent meta-analysis of 22 trials of CAB involving over 5,000 patients showed a non-significant improvement in survival with CAB over castration, but had a number of methodological weaknesses, whereas a sensitivity analysis of published data showed a clear survival benefit. It is hoped that the results of a very large well-designed trial by the National Cancer Institute Intergroup (NCI INT-0105), in which 1,347 men have been randomised to orchidectomy plus flutamide (Eulexin, Schering-Plough International) or orchidectomy plus placebo will provide the definitive answer to this continuing controversy.