A critical review of maximal androgen blockade for advanced prostate cancer.

For over 60 years, the primary treatment for metastatic prostate cancer has been androgen ablation. Medical or surgical castration eliminates most, but not all androgen production, with a small contribution still coming from the adrenal gland. When castration fails, secondary adrenalectomy can provide some palliative benefit. However, the development of oral antiandrogens has offered an opportunity to simultaneously interfere with androgen produced in the testes and adrenal gland. Combined androgen blockade (CAB) has been investigated extensively with conflicting results. Based on a critical review of these studies, CAB still appears to offer the longest duration of survival and should continue to be offered as an option to men with metastatic disease.