Prostate cancer: 9. Treatment of advanced disease
| Table 1: Relative beneifts of various forms of medical castration* | ||||||
| Benefit | Therapeutic option; degree of benefit | |||||
| LH-RH alone | CPA alone | Lead-in CPA + CAB† | CAB + nonsteroidal anti-androgen | CAB + CPA | CPA + DES | |
| Rapid onset | – | + | ++ | + | + | ++ |
| Reversibility | ++ | ++ | ++ | ++ | ++ | ++ |
| Absence of flare | – | ++ | ++ | + | + | ++ |
| Absence of hot flushes | – | + | + | – | + | + |
| Low toxicity | + | + | ++ | – | + | + |
| Low cost | – | + | – | – | – | ++ |
| Ease of administration | ++ | ++ | + | + | + | ++ |
| Note: LH-RH = luteinizing-hormone releasing hormone, CPA = cyproterone acetate, CAB = combined androgen blockade (LH-RH + steroidal anti-androgen).DES = diethylstilbestrol. *The relative merits assigned in this table represent the authors' own views, which are based on the use of multiple drug regimens over the years to produce androgen ablation. †CPA used as lead-in therapy for first month to prevent flare. |
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