Combined Androgen Blockade : Prostate
By prostate Doc at 7 October, 2008, 6:58 pm
It was proposed in the 1980s that testicular androgen deprivation combined with an antiandrogen would be superior to testicular androgen deprivation alone. This is referred to as combined androgen blockade (CAB) or maximal androgen blockade (MAB).
This concept is based on the theory that an antiandrogen will block adrenal androgens at the cellular level, enhancing the primary androgen suppression pro- vided by orchiectomy or a LHRH agonist. There have been a number of large, pro- spective, randomized clinical trials which have compared CAB to monotherapy (primary androgen deprivation). A number of these trials demonstrated benefit for CAB, although the largest trial including 1,300 men randomized to orchiectomy with or without flutamide failed to demonstrate a difference in either progression-free or overall survival. Two meta-analyses examining all available data came to conflict- ing conclusions about the value of CAB. The issue remains unsettled, particularly when the additional variable of intermittent therapy is considered.
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