Does Prolonged Combined Androgen Blockade Have Survival Benefits Over Short-Term Combined Androgen Blockade Therapy?

Reviewers: Li Liu, MD
Source: Urology, Volume 55:391396, (March) 2000

Introduction

The therapeutic value of combined androgen blockade (CAB), the pairing of antiandrogen therapy with medical or surgical castration for the treatment of advanced prostate cancer, has been investigated over the last few decades. However, the optimal duration of CAB treatment remains an open question. In this study, the researchers assessed the survival difference between patients who had prolonged and short-term CAB treatment.

Method

A total of 813 patients with stage D2 prostate cancer received an antiandrogen, either 50 mg bicalutamide once daily or 250 mg flutamide t.i.d. The patients also received a monthly depot preparation of a luteinizing hormone-releasing hormone agonist, either 7.5 mg leuprolide or 3.6 mg goserelin.

Results

• Patients who received the CAB therapy for 120 days or more survived for a mean of 1,035 days compared with 302 days for those who received it for less than 120 days.
• In patients who lived at least 2 years beyond the start of the trial, the survival time in those who received CAB for 120 or more days was increased by 35%.

Discussion

In this study, patients with stage D2 prostate cancer who received combined androgen blockade therapy for 120 days tended to live longer than those who received shorter-term therapy. The immediate question would be how long is long enough. Since CAB treatment dose has long-term side effects, more studies are needed to evaluate the optimal duration of CAB treatment.