IS PREDNISOLONE AS GOOD AS FLUTAMIDE IN HORMONE-REFRACTORY METASTATICCARCINOMA OF THE PROSTATE

Purpose: There are no generally accepted rules for the second line tre atment of prostate cancer and few prospective studies have attempted t o compare 2 therapeutic strategies with different modes of action. Mat erials and Methods: We describe a prospective, randomized study of 40 patients comparing the second line response of flutamide to prednisolo ne in patients with known hormone refractory stage M1 prostate cancer. Results: The median survival of patients receiving either treatment w as 32.9 weeks, with no difference between the 2 groups. In terms of bi ological response 11 of 20 patients (55%) receiving prednisolone and 1 0 of 20 (50%) receiving flutamide exhibited prostate specific antigen (PSA) suppression. Average minimum PSA was 54 and 52% of the initial P SA in patients receiving prednisolone and flutamide, respectively. The re was no difference between the 2 treatment groups in terms of long-t erm survival, although 35% of all patients survived beyond 1 year and 3 survived beyond 2 years. Conclusions: More patients taking prednisol one described better pain relief, although both medications were well tolerated and there was no difference in terms of performance status o r analgesic requirements.