Antiandrogen monotherapy: a new form of treatment for patients with prostate cancer

• Published in: Urology (Ridgewood, N.J.) Vol. 58; no. 2; pp. 16 - 22
• Main Authors: Kolvenbag, Geert J.C.M, Iversen, Peter, Newling, Don W.W
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2001
• Subjects: Androgen Antagonists - therapeutic use; Anilides - therapeutic use; Antineoplastic Agents, Hormonal - therapeutic use; Flutamide - therapeutic use; Humans; Imidazoles - therapeutic use; Imidazolidines; Male; Meta-Analysis as Topic; Nitriles; Orchiectomy; Prostatic Neoplasms - drug therapy; Prostatic Neoplasms - surgery; Quality of Life; Tosyl Compounds; Treatment Outcome
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/S0090-4295(01)01237-7

Nonsteroidal antiandrogens are generally used in conjunction with castration as combined androgen blockade. However, the changing profile of patients with prostate cancer has made monotherapy with a nonsteroidal antiandrogen an attractive alternative therapeutic approach, offering potential quality-of-life benefits over conventional treatment modalities. Of available antiandrogens, monotherapy with bicalutamide has been most extensively evaluated. Combined data from 2 studies at a median follow-up time of 6.3 years revealed no statistically significant difference in overall survival between bicalutamide 150-mg monotherapy and castration in patients with nonmetastatic locally advanced disease. In patients with metastatic disease, there was a statistically significant difference (6 weeks) in overall survival in favor of castration. Bicalutamide monotherapy is associated with significant quality-of-life benefits (sexual interest and physical capacity), with preliminary data suggesting that the risk of osteoporosis may also be reduced by bicalutamide 150-mg monotherapy compared with castration. In general, bicalutamide is well tolerated, with a predictable adverse-effect profile. Breast pain (40%) and gynecomastia (49%) are the most common adverse events seen during monotherapy with this drug. In summary, the availability of bicalutamide 150-mg monotherapy broadens treatment options for men with locally advanced prostate cancer, offering a viable and attractive alternative to castration in this patient population. Ongoing studies will determine the role of bicalutamide in the treatment of localized disease.