ANTIANDROGENS AS MONOTHERAPY FOR PROSTATE-CANCER

Castration or antiandrogen monotherapies remain options for prostate c ancer 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, bicalutamid e 150 mg was as effective as castration in MO patients with significan t 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 monothe rapy and there are little data on flutamide. The steroidal antiandroge n, 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 c ompleted EORTC study, side effects such as gynaecomastia, diarrhoea, n ausea, and liver function deterioration occurred less often, and throm botic effects more often, in the cyproterone acetate group. No differe nce was seen in the preservation of sexual functioning. Quality of lif e issues are becoming increasingly important and thus antiandrogen mon otherapy may become more widely used in the management of prostate can cer.