Antiandrogens in the treatment of prostate cancer.

OBJECTIVES: To give an overview on the contemporary role of antiandrogens in prostate cancer treatment.
METHODS: A review of the literature was performed concerning pharmacologic properties, possible indications and side effects of antiandrogens in the treatment of early and advanced prostate cancer.
RESULTS: One steroidal and three non-steroidal antiandrogens are in common use for the treatment of prostate cancer. Monotherapy with non-steroidal antiandrogens may prevent osteoporosis, loss of musculature and may preserve sexual activity in a proportion of patients and therefore has advantages in quality of life compared to castration. In patients with localized disease managed by watchful waiting or in an adjuvant setting, there are no studies showing an advantage in early versus delayed treatment with antiandrogens regarding clinical progression. In locally advanced non-metastatic prostate cancer, antiandrogen monotherapy seems to be an alternative to castration treatment if treatment is required. In patients with metastatic disease and a high tumor burden, antiandrogen monotherapy is inferior to castration. In advanced disease, combined androgen blockade can provide a small survival advantage, which, however, has to be balanced against increased side effects and costs.
CONCLUSIONS: Antiandrogens are a treatment option in some patients with prostate cancer. However, it has to be taken into account that the hormonal effect is inferior to castration.