256 Step-Up From Castration to Combined Androgen Blockade May Prolong Hormonal Response in Locally Advanced Prostate Cancer

How Multidisciplinary Teams (MDTs) Work in Practice in the Management of Advanced Prostate Cancer: A Survey of Oncologists and Urologists in the UK

“…In the UK, first-line management of advanced prostate cancer is usually with an LHRHa alone with the addition of an antiandrogen as secondline treatment. A retrospective analysis of 122 patients treated with bicalutamide 50 mg in addition to goserelin for disease progression showed a >50% decrease in PSA levels in 30% of patients (responders) and some reduction in PSA in 75% overall [4]. The median duration of response from the start of bicalutamide was 291 days for responders and 193 days for the whole population.…”

Advanced prostate cancer – optimising and integrating care

“…Unlike mHRPC, which is resistant to all further hormonal manipulation, mCRPC can remain hormone sensitive, and indeed may be supersensitive to very low levels of androgen. As such, continued androgen deprivation with LHRH agonists, the addition of antiandrogens to achieve combined androgen blockade, 6 or further hormonal manipulation with antiandrogen withdrawal, 7 oestrogens 8 or corticosteroids such as dexamethasone 0.5mg, 9 may all represent effective further treatment strategies.…”

The Evolution and Current Paradigm of Chemotherapy for Metastatic Castrate-Resistant Prostate Cancer

“…In practice, 'step-up' CAB, with the addition of an anti-androgen at the time of the first relapse on castration-based therapy is common practice in the UK--first-line CAB is rarely offered, in order to reduce any additional toxicity at first presentation. A retrospective analysis of PSA levels in 122 patients receiving the LHRH agonist goserelin, with the addition of the anti-androgen bicalutamide 50 mg on PSA and clinical progression, showed a greater than 50% decrease in PSA levels in 30% of patients (responders) and a quantifiable reduction in PSA in 75% of all patients [19]. The median duration of response from commencement of bicalutamide was 291 days for responders and 193 days for the population as a whole.…”