A controlled trial of castration with and without nilutamide in metastatic prostatic carcinoma

Article Abstract:

It has been almost 50 years since the first studies demonstrated that depriving prostate cancer cells of androgens, or male sex hormones, can provide some therapeutic benefit. The majority of patients respond to androgen blockade, which is achieved by hormonally suppressing androgen synthesis in the testes or surgically removing the testes. However, after a positive initial response to androgen blockade, a large proportion of patients relapse. In some cases, the relapsing cancers have been shown to be androgen sensitive; this suggests that the small amount of androgens synthesized in the adrenal glands may be of clinical importance. The surgical removal of the adrenal glands, or their medical inactivation, introduces deficiencies in a great many other hormones, and is generally not considered to be a useful adjunct to the treatment of prostate cancer. However, a new class of drugs may provide some advantage. These drugs, known as nonsteroidal antiandrogens, work by blocking the action of the androgens within the target cell. Therefore, it seems reasonable to deprive advanced prostate cancers of most of their supply of male hormones by castration, and to use antiandrogens to block the effect of the small amounts that continue to be made available by the adrenal glands. To evaluate the effectiveness of this approach, 203 patients with advanced prostate cancer were treated surgically and randomly assigned to receive either placebo or nilutamide, a nonsteroidal antiandrogen. The patients treated with castration and nilutamide achieved a greater proportion of successful responses to therapy, 46 versus 20 percent. However, the differences in overall survival were less striking. The median survival time of the patients receiving both surgical and drug therapies was 24.3 months, compared to the median of 18.9 months for the patients who were castrated. The results indicate that the combined treatment offers only modest benefit to patients with advanced prostate cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Patient outcomes, Mortality, Nilutamide

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Hormonal therapy of prostatic carcinoma: defining the challenge

Article Abstract:

More than 28,000 men are expected to die of prostate cancer this year. The number will rise in future years as the average age of the population increases. Over half of all patients with prostate cancer already have advanced disease at the time of initial diagnosis and are, therefore, not good candidates for surgical removal of the prostate and radiation therapy. For patients whose prostate cancer has already begun to spread, the average survival is 1.8 years. Since prostate cancer is dependent upon androgens, or male hormones, current treatments focus on reducing the levels of the male hormones as much as possible. This can be accomplished by using drugs that interfere with the stimulation of androgen production by pituitary hormones, or by removing the testes, the site where most androgens are produced. The best way of accomplishing androgen depletion remains uncertain. In addition, studies have not determined the importance of neutralizing the androgens from the adrenal gland, a minor, but not negligible, contributor to male sex hormones. To identify optimal treatment methods, the variety of therapeutic options requires the effective design of clinical trials. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Introduction to the Workshop on Combined Castration and Androgen Blockade Therapy in Prostate Cancer

Article Abstract:

On September 19 and 20, 1989, the American Cancer Society convened a meeting to bring together many of the world's foremost researchers of advanced prostate cancer. Their purpose was to resolve some of the complex issues facing treatment of this condition. Some investigators feel that the combination of castration and antiandrogen drugs, which deprive prostate cancers of male hormones, is the best treatment available, but there is no consensus on this point. Many published reports in the medical literature contain contradictory results; this not only calls into question the validity of the results, but the basic experimental methodology as well. Also questionable is the technique of meta-analysis, in which data from different studies are pooled to achieve greater statistical reliability. It is far from clear that such pooling of data is valid when there are fundamental differences in experimental techniques. The results of the conference represent less of a final word on a treatment technique for advanced prostate cancer than a stepping stone from which further research may proceed to answer these questions. (Consumer Summary produced by Reliance Medical Information, Inc.)

Conferences, meetings and seminars, Testis, editorial, Testicular surgery

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