Current status of combined androgen blockade: optimal therapy for advanced prostate cancer.

CAB represents the gold standard of treatment for patients with advanced prostate cancer. The treatment is well-tolerated with the only increased side effect being a 6% increase in diarrhea. Ninety-five percent of patients benefit, and those having minimal metastatic disease show a marked benefit. Since maximal androgen blockade seems to be of major benefit for patients with good performance status and minimal disease, its role needs to be investigated in patients with earlier stages of prostate cancer including stages B, C, and D1. Important trials are underway to address these provocative issues. Progress in the treatment of patients who relapse with metastatic prostate cancer after initial CAB will probably come to rely on the discovery and development of novel drugs or innovative drug delivery systems. Immunomodulatory drugs to enhance the body's natural defenses, monoclonal antibodies directed against prostate specific cellular antigens and tagged with radioisotopes or cytotoxic agents, and bone-seeking radiopharmaceuticals may represent the breakthrough that is needed. Exciting advances in gene therapy may represent the ultimate chance for a cure.