How to best treat men with a prostate cancer PSA only recurrence (biochemical recurrence) still remains controversial. Hormone therapy (ADT) using a combination of a 5-alpha reductase inhibitor and an antiandrogen without conventional gonadal androgen suppression (where testosterone levels are not suppressed) may allow control of the prostate-specific antigen (PSA) with less morbidity.
In a small study men with a biochemical recurrence with no other evidence of recurrent disease received both finasteride, 5 mg orally per day, and flutamide, 250 mg orally 3× a day. Patients were followed for a PSA response and quality of life assessment.
Ninety-nine of 101 accrued patients were eligible to have data included in the study.
1- A ?80% PSA decline was seen in 96 (96%) patients.
2- Their median time to PSA progression was 85 months.
3- With a median follow-up of 10 years, the median survival time had not been reached, and the 5-year overall survival rate was 87%.
4- Toxicity was mild, with 18 patients stopping for toxicity; 15 had diarrhea, 4 had gynecomastia, and 3 had transaminase elevation.
5- Baseline Functional Assessment of Cancer Therapy Prostate Module and Treatment Outcome Index scores decreased by 5 points each at 6 months after enrollment.
The use of the finasteride/flutamide combination is feasible, and results in PSA declines of ?80% in 96% of patients with serologic progression after definitive local therapy. There were no unexpected toxicities, and the change in quality of life was mild. Further evaluation of this or a similar regimen in a controlled clinical trial is warranted.
Cancer 2012;. © 2011 American Cancer Society. Article first published online: 16 DEC 2011DOI: 10.1002/cncr.26732
Joel T Nowak, M.A., M.S.W.