Maximum androgen blockade: A case study report

The use of maximum androgen blockade (MAB) in advanced prostate cancer remains controversial due to conflicting data from clinical trials. Some of the trials that report no advantage of MAB over monotherapy have been criticized on a number of points, including a lack of statistical power and too short a follow-up period. Three randomized trials, SWOG-INT 0036, EORTC-30853 and the Anandron Study Group Trial, report a survival advantage and a longer time to disease progression with MAB, although only one reaches statistical significance. The widespread use of MAB is controversial on the basis of the available clinical data. It has been suggested that three clinical situations exist for its use in advanced cancer: in symptomatic disease; as neoadjuvant therapy prior to radiotherapy; and for the prevention of flare following the use of luteinizing-hormone-releasing hormone analogues as monotherapy. Case studies are presented in this article involving the use of MAB in these circumstances, as well as its use under other conditions. MAB fits into an algorithm of progressive step-up therapy and by tailoring hormonal therapy to individual patients and their tumours we may improve survival and define further the future role of MAB.