ARE NONSTEROIDAL ANTI-ANDROGENS APPROPRIATE AS MONOTHERAPY IN ADVANCED PROSTATE-CANCER

Objectives: To evaluate the efficacy of non-steroidal anti-androgen mo notherapy in the treatment of advanced prostate cancer. Methods: The p ertinent literature regarding the use of nilutamide, flutamide, and bi calutamide as monotherapy in the treatment of prostate cancer has been reviewed. Results: The clinical utility of non-steroidal antiandrogen monotherapy is currently under investigation. As with other endocrine therapies, this approach appears to provide effective palliation of s ymptoms, but offers certain quality-of-life benefits, including preser vation of libido and sexual potency, issues which may be important in certain patients, particularly younger men. Available data indicate th at flutamide may be as effective as orchidectomy in terms of prolongin g progression-free survival in selected patients. Nilutamide has been less extensively investigated, but the clinical utility of this agent, except for use in combined therapy, would appear to be somewhat limit ed by a high incidence of drug-related side effects. Bicalutamide, how ever, is well tolerated as monotherapy and appears to be as effective as castration in patients with locally advanced non-metastatic disease . In metastatic disease, the improved subjective response and quality of life gains with bicalutamide may outweigh the slightly inferior sur vival. Conclusion: These promising preliminary findings, a number of i ssues remain to be determined before non-steroidal antiandrogen monoth erapy can be considered to be routine clinical practice. These include optimum indication and dosage, long-term clinical efficacy and tolera bility, and response to second-line therapy.