Antiandrogen withdrawal in the treatment of hormone-relapsed prostate cancer: Single institutional experience

Objectives: Locally advanced and metastatic prostate cancer eventually prog resses in spite of complete androgen blockade. Second-line therapy is usual ly disappointing, and further progression is the rule. Laboratory and clini cal data have indicated that antiandrogen withdrawal may be a valuable stra tegy in the treatment of these patients. However, after antiandrogen withdr awal, controversial clinical results have been reported, Therefore every co ntribution to this therapeutic strategy is useful. Methods: Herein we prese nt our experience with antiandrogen discontinuation in a series of 44 patie nts with locally advanced or metastatic prostate cancer treated with comple te androgen blockade (CAB), Results: Prostate-specific antigen (PSA) declin e was observed in 13 of 44 (29%) and in 11 of these patients the reduction was greater than 50%. No response or further progression after antiandrogen withdrawal was observed in 31 of the 44 patients (71%). Among these patien ts 14 died due to prostate cancer after a mean period of 5.6 months. No pat ient in the responding group has died, Conclusions: Our data indicate that approximately 30% of patients with advanced prostate cancer treated with CA B respond to antiandrogen withdrawal with a reduction in serum PSA levels. Even though it is not clear whether this PSA reduction produces a benefit i n terms of survival, we feel that antiandrogen withdrawal must be the first therapeutic maneuver in patients with advanced prostate cancer who progres s after CAB, If there is no PSA response within 4 months, second-line treat ment is necessary, Copyright (C) 2001 S. Karger AG, Basel.