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- Title
Efficacy of peripheral androgen blockade in prostate cancer patients with biochemical failure after definitive local therapy: results of Cancer and Leukemia Group B (CALGB) 9782.
- Authors
Monk JP; Halabi S; Picus J; Hussain A; Philips G; Kaplan E; Ahles T; Gu L; Vogelzang N; Kelly WK; Small EJ; Cancer and Leukemia Group B; Monk, J Paul; Halabi, Susan; Picus, Joel; Hussain, Arif; Philips, George; Kaplan, Ellen; Ahles, Tim; Gu, Lin
- Abstract
<bold>Background: </bold>The treatment for prostate cancer patients with biochemical failure after local therapy remains controversial. Peripheral androgen blockade using a combination of a 5-alpha reductase inhibitor and an antiandrogen may allow control of the prostate-specific antigen (PSA). Because testosterone levels are not suppressed, this approach may be associated with less morbidity than conventional gonadal androgen suppression.<bold>Methods: </bold>All patients had undergone previous definitive local therapy and had evidence of a rising PSA >1ng/mL, with no evidence of recurrent disease. Patients 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.<bold>Results: </bold>Ninety-nine of 101 accrued patients were eligible. A ≥80% PSA decline was seen in 96 (96%) patients. The median time to PSA progression was 85 months. 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%. Toxicity was mild, with 18 patients stopping for toxicity; 15 had diarrhea, 4 had gynecomastia, and 3 had transaminase elevation. Baseline Functional Assessment of Cancer Therapy Prostate Module and Treatment Outcome Index scores decreased by 5 points each at 6 months after enrollment.<bold>Conclusions: </bold>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.
- Publication
Cancer (0008543X), 2012, Vol 118, Issue 17, p4139
- ISSN
0008-543X
- Publication type
journal article
- DOI
10.1002/cncr.26732