One of the first treatments used when diagnosed with advanced or recurrent prostate cancer is hormone therapy. Hormone therapy (androgen blockade) is a systematic treatment, or it treats the cancer through the entire body. Prostate cancer that is believed to be in the gland is treated with a localized, focused treatment of the actual gland only.

The preferred androgen blockade involves the use of an anti-androgen (i.e. bicalutamide or casodex) with a drug that is designed to bring about castration (LHRH drug i.e. Lupron). This treatment is referred to as combined androgen blockage (CAB). Use of CAB has been assessed in over 30 studies and a meta-analysis suggests that when non-steroidal anti-androgens (bicalutamide or Casodex) are used there is a survival benefit with risk of death reduced by 8%. In the journal Cancer, Professor Hideyuki Akaza and collaborators report on a multicenter, double blind, controlled trial comparing CAB using the anti-androgen bicalutamide (80mg, the licensed dose for Japan) vs. castration (LHRH drug) alone.

The study used 205 Japanese men with advanced prostate cancer at 49 different centers between 2000 and 2001. Randomized treatment was given in a double-blind manner until September 2002 when the code was broken for ethical reasons. All of the men continued to receive treatment until November 2003 or until there was disease progression. In the LHRH monotherapy arm, patients experiencing disease progression were offered the option to add bicalutamide to their treatment regimen. The demographic and baseline characteristics of subjects were similar between the both treatment arms.

At a median follow-up of 5.2years, there were fewer overall deaths with CAB than with LHRH-A monotherapy (26 vs. 38 deaths, respectively). This was a significant overall survival advantage in favor of CAB. The 5-year overall survival rate estimated by Kaplan-Meier method was 75.3% for CAB vs. 63.4% for LHRH-agonist monotherapy. Cause-specific deaths were 14 in the CAB groups and 22 in the LHRH-agonist group, which was not statistically significant. PSA nadir to <0.1ng/ml was reached in 81.4% of men on CAB and by 33.7% of men on LHRH-agonist therapy. A PSA nadir was strongly associated with overall survival. It is a shame that the dosing of drugs is not standard through out the world. Can men in countries where the standard dose of the androgen blockade drugs are different count on experiencing similar results? In the United States, the standard anti-androgen dosage is 50mg as opposed to the 80mg taken by the subjects in this study. Despite this dosage difference, I will continue to insist that I receive both types of drugs (ADT2) when I go back on a blockade. Cancer. 2009 Jun 17;115(15):3437-3445 10.1002/cncr.24395, Akaza H, Hinotsu S, Usami M, Arai Y, Kanetake H, Naito S, Hirao Y PubMed Abstract PMID: 195368 Joel T Nowak MA, MSW