Antiandrogens as monotherapy for prostate cancer

Castration or antiandrogen monotherapies remain options for prostate cancer treatment as only marginal benefits have been demonstrated with combined androgen blockade, although it may be that certain subgroups of patient may benefit. Of the nonsteroidal antiandrogens, bicalutamide 150 mg was as effective as castration in M0 patients with significant improvement in sexual interest and physical capacity, but the trial has yet to reach maturity. In M1 patients, bicalutamide 150 mg was not as effective as castration but this may be outweighed by symptomatic and quality of life benefits. Nilutamide is not recommended as monotherapy and there are little data on flutamide. The steroidal antiandrogen, cyproterone acetate, is as effective as oestrogen therapy and has a better side-effect profile, although cardiovascular and hepatic side effects are still of concern. Compared with flutamide, in a recently completed EORTC study, side effects such as gynaecomastia, diarrhoea, nausea, and liver function deterioration occurred less often, and thrombotic effects more often, in the cyproterone acetate group. No difference was seen in the preservation of sexual functioning. Quality of life issues are becoming increasingly important and thus antiandrogen monotherapy may become more widely used in the management of prostate cancer.