Combined Antiandrogen Treatment

Labrie, a French Canadian, has made a great contribution to prostate cancer treatment, and suggested that in a disease that is androgen sensitive it is important to eliminate all sources of androgen. Labrie advocated the use of a combination of an antiandrogen with an LHRH agonist in the treatment of prostate cancer. The sources of androgen supplied to the prostate are dietary, adrenal, and testicular. The use of an antiandrogen, such as flutamide, potentially has the benefit of acting synergis-tically with GnRH agonist. Labrie's early work was not based on any randomized study, and so was not greeted with universal acceptance, but rather the opposite! However, his opinion has been vindicated by randomized controlled trials and meta-analyses of these studies. The randomized trials show a 7-month survival advantage to combination antiandrogen treatment. The meta-analyses, however, do not look at survival advantage, but at overall 5-year survival, and these report a 3% benefit to combination therapy as compared with monotherapy at 5 years. This would appear to be a bizarre time point to use as an assessment, in a disease with a median survival of 3 years. For the clear reason that there is a 7-month survival advantage, it would appear that the appropriate practice recommendation is for combination therapy.

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