Ansari MS et al. (2004) Combined androgen blockade in the management of advanced prostate cancer: a sensible or ostensible approach. Int J Urol 11: 1092–1096

A recent study by Ansari and colleagues has shown that orchiectomy alone was equally as effective as orchiectomy plus flutamide in the treatment of men with metastatic carcinoma of the prostate.

The study included 100 patients with advanced prostate cancer who were randomized in a 1:1 ratio to orchiectomy alone (O) or orchiectomy plus flutamide (OF), and were followed up for a mean period of 3.5 years. The maximum percentage decrease in serum PSA levels was similar in both groups (95% and 97% for groups O and OF, respectively), and occurred during the first 3 months after orchiectomy. This decrease in PSA persisted for 3 years in more than 80% of patients in both groups. There was no significant difference between the O and OF groups in the proportion of patients experiencing complete or partial response, as indicated by serum PSA levels and bone scan findings. The mean time to progression was 27 and 29 months in the O and OF groups, respectively, and overall survival was similar in the two groups at 3 years (45.8% vs 48.1%) and 5 years (20.8% vs 23.1%).

In summary, total androgen blockade was not superior to orchiectomy alone in decreasing serum PSA in this study, and overall survival was similar using the two strategies. The authors, therefore, advise against the routine addition of flutamide in patients undergoing orchiectomy.