Abstract
Prostate cancer is androgen dependent, and the mainstay of treatment for advanced disease is androgen deprivation. The combination of an antiandrogen with castration (maximal androgen blockade [MAB]) may be the most effective method to reduce the level of systemic androgens, including dihydrotestosterone. However, randomised studies evaluating the value of MAB over castration alone have produced conflicting results. Recent meta-analyses suggest that MAB using non-steroidal antiandrogens (NSAAs) achieves better overall survival than MAB using steroidal antiandrogens. MAB using NSAAs was associated with a 3% increase in 5-year overall survival compared with castration alone. Bicalutamide (‘Casodex’) is an established component of MAB as first-line treatment for advanced prostate cancer. Recent data indicate that bicalutamide may also be an effective second-line treatment for patients who progress on conventional hormone therapy. Results of meta-analyses conducted to evaluate whether MAB prolongs overall survival in patients with advanced prostate cancer are discussed. Trials and case histories examining the use of MAB using the NSAA bicalutamide are also presented.
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