Use of the nonsteroidal anti-androgen Casodex in advanced prostatic carcinoma.

Pure anti-androgens have advantages over steroidal anti-androgens of the cyproterone acetate type in the treatment of patients with advanced prostate cancer because they do not have steroidal side effects or such a marked inhibitory effect on libido. In addition, the long half-life of a pure anti-androgen such as Casodex results in maintenance of high serum anti-androgen concentrations, which allays concern over the clinical significance of any small rise in serum testosterone concentrations. The anti-androgen of choice for the treatment of androgen-responsive diseases has yet to be defined. However, this choice should be based on extensive clinical evaluations of a drug as monotherapy. As always, the clinical efficacy and tolerability of the drug will be important factors in determining the anti-androgen of choice; however, favorable pharmacokinetics should be emphasized in the treatment of a disease in which high and sustained concentrations of antagonist must be present to prevent androgenic stimulation. Casodex, a pure anti-androgen with a relatively long half-life, produces objective and subjective responses similar to those of surgical or pharmacologic castration and is well tolerated. Its profile makes it a strong candidate for consideration as the future anti-androgen of choice in the treatment of advanced prostate cancer.