Which is the optimal antiandrogen for use in combined androgen blockade ofadvanced prostate cancer? The transition from a first- to second-generation antiandrogen

Many physicians use combined androgen blockade in the form of a luteinizing hormone-releasing hormone analog or bilateral orchiectomy in combination w ith a non-steroidal antiandrogen to offer patients a potentially more effec tive treatment than castration alone. Three non-steroidal antiandrogens are available in the US, i.e. flutamide (Eulexin), bicalutamide (Casodex) and nilutamide (Nilandron). Nilutamide offers patients no benefit over flutamid e or bicalutamide and has the least favorable safety profile. Because of it s short half-life, flutamide must be administered 3 times a day. Furthermor e, flutamide therapy is associated with a relatively high incidence of diar rhea, often intolerable for some patients. Bicalutamide is available in a c onvenient one tablet, once-a-day dosing regimen, is at least as effective a s flutamide and is better tolerated in terms of diarrhea. Therefore, bicalu tamide would seem to represent an appropriate first choice in patients who are suitable candidates for combined androgen blockade. [(C) 1999 Lippincot t Williams & Wilkins.].