�UroToday.com - In the September, 2008 issue of the Journal of Urology, Dr. Hiroyoshi Suzuki and Japanese collaborators reported that following utmost androgen seal off (MAB) for prostate crab (CaP), the use of alternative nonsteroidal antiandrogens is effective for treating relapsed disease. A total of 232 CaP patients treated with MAB and disease progression made up the study cohort. Upon disease relapse they were treated with an alternative antiandrogen.
For first-line therapy, 39 men received MAB victimisation flutamide and 193 were treated with MAB using bicalutamide. At the time of CaP progression, the first line antiandrogen was stopped and patients assessed for antiandrogens withdrawal syndrome. Second line antiandrogens were then started. Testosterone was confirmed to be in the emasculate level. Standard disease response criteria were used.
All patients achieved castrate levels of testosterone. Mean patient age was 71.5 years and PSA ahead treatment was 1,047ng/ml. Of the 193 men initially tempered with bicalutamide, 143 (74%) achieved a complete reply (CR) and all attained a CR or partial response (RP). Of the 39 flutamide treated patients, 32 (82%) achieved a CR and all attained a CR or PR. The duration of the first line MAB response was 452 days and cause-specific survival was significantly improved in the CR patients compared to the non-CR manpower. Antiandrogen withdrawal response rates were 15.5% for bicalutamide and 12.8% for flutamide. Second line alternative antiandrogen treatment was effective careless of antiandrogens withdrawal syndrome status.
Second line alternative antiandrogen agents resulted in an overall PSA decrease of 50% or greater in 35.8% and a PSA response of 0 to 50% was noted in 25.4%. There was no remainder with esteem to response between bicalutamide and flutamide. Seventy of the 83 good responders had response duration of 202 days. More than half of the patients that had started mo line therapy at a PSA point
Suzuki H, Okihara K, Miyake H, Fujisawa M, Miyoshi S, Matsumoto T, Fujii M, Takihana Y, Usui T, Matsuda T, Ozono S, Kumon H, Ichikawa T, Miki T
J Urol. 2008 Jul 15. Epub in front of print.
doi:10.1016/j.juro.2008.05.045
Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS
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