The role of antiandrogen monotherapy in the treatment of prostate cancer

Abstract

SUMMARY The mainstay of hormonal therapy in prostate cancer has been medical or surgical castration, both of which are associated with loss of libido and impotence, and may not always be acceptable to the patient. Antiandrogen monotherapy is an alternative treatment option to castration. There are two types of antiandrogen, i.e. steroidal (cyproterone acetate, CPA), and nonsteroidal (bicalutamide, flutamide and nilutamide). Data comparing survival outcome with CPA and castration are limited and conflicting. Furthermore, CPA is associated with loss of libido and erectile dysfunction. Large phase III trials have established that monotherapy with bicalutamide 150 mg once daily provides a survival outcome that is not significantly different to that after castration in men with locally advanced, non‐metastatic disease, while conferring significant advantages for sexual interest and physical capacity. Current data are inadequate to draw conclusions on the comparative efficacy of flutamide and castration, while nilutamide is not licensed for monotherapy. Recent data reveal that bicalutamide 150 mg given once daily in addition to standard care (radical prostatectomy, radiotherapy or ‘watchful waiting’) significantly delays the progression of early (localized or locally advanced) prostate cancer. Bicalutamide has a more favourable side‐effect profile than the other antiandrogens and is more likely to promote compliance.

Differential mechanisms of bicalutamide-induced apoptosis in prostate cell lines

“…Owing to its tolerable side effect profile, ease of administration and long half-life, it offers an attractive alternative to the steroidal antiandrogens. 2 Clinically, it may be used as a single agent 3 or in combination with luteinizing hormone-releasing hormone analogues. Ostensibly, it functions as a receptor antagonist, preventing the binding of dihydrotestosterone.…”

Late - Onset Hypogonadism - New Point of View

“…On the other hand, it is recognized that testosterone deficiency is considered to be of little importance in the development of erectile dysfunction or in life force. (Anderson, 2003, Montorsi et al, 2003. There was no sexual orientation change in men who underwent surgical castration.…”

Prostate Cancer: Current and Emerging Therapies

“…CPA is one of the least studied anti-androgen. Conversely, bicalutamide is the most extensively studied nonsteroidal anti-androgen [26]. Lowered percentages of hot flashes as compared with castration have been reported with bicalutamide, flutamide and CPA treatment.…”