Volume 12, Issue 5 (September 2010) 12, 718–727; 10.1038/aja.2010.42
Efficacy of maximal androgen blockade versus castration alone in the treatment of advanced prostate cancer: a retrospective clinical experience from a Chinese medical centre
Xue-Qin Chen1,*, Ying Huang1,*, Xiang Li2, Peng Zhang2, Rui Huang3, Juan Xia1, Ni Chen1, Qiang Wei2, Yu-Chun Zhu2, Yu-Ru Yang2 and Hao Zeng2
1 Laboratory and Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, China
2 Department of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
3 Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
* These two authors contributed equally to this work.
Correspondence: Dr Hao Zeng,firstname.lastname@example.org
Received 10 February 2010; Revised 22 March 2010; Accepted 21 April 2010; Published online 9 August 2010.
In this retrospective study, we evaluated and compared the efficacy and toxicities of maximal androgen blockade (MAB) versus castration alone in Chinese patients with advanced prostate cancer. From 1996 to 2004, 608 patients with advanced prostate cancer were included in the study. Patients were retrospectively divided into two groups according to different therapeutic regimens. Of the 608 patients, 300 patients were treated with MAB (castration plus nonsteroidal antiandrogens) and the remaining 308 were treated with castration alone. The 2- and 5-year overall survival rates of these patients were 73.7% and 56%, respectively. Multivariate analysis showed that, in patients with metastatic prostate cancer, MAB was associated with not only the improvement of progression-free survival (PFS) (increased by 10 months) but also a 20.6% reduction in mortality risk compared with castration alone. In contrast, the efficacy of MAB was not superior to castration alone for patients with nonmetastatic prostate cancer. Interestingly, among patients with MAB, those using bicalutamide had a longer PFS than those using flutamide; this was especially so in patients with metastatic prostate cancer. Almost all of the toxicities due to the hormone therapy were mild to moderate and manageable. To conclude, in China, hormone therapies, including MAB and castration alone, have been standard treatments for advanced prostate cancer. For patients with nonmetastatic prostate cancer, castration alone might be adequately practical and efficient. In patients with metastatic prostate cancer, however, MAB has superior efficacy over castration alone. It is clear that MAB should be considered the first-line standard treatment for patients with metastatic prostate cancer.
bicalutamide; castration alone; maximal androgen blockade; prostate cancer