Finasteride and bicalutamide as primary hormonal therapy in patients with advanced adenocarcinoma of the prostate

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Abstract

Background: Medical or surgical castration is effective in advanced prostate cancer but with profound side-effects, particularly on sexual function. Effective, less toxic therapies are needed. This study examined whether the addition of finasteride to high-dose bicalutamide enhanced disease control, as measured by additional decreases in serum prostate-specific antigen (PSA). Patients and methods: Forty-one patients with advanced prostate cancer received bicalutamide (150 mg/ day). Finasteride (5 mg/day) was added at first PSA nadir. Serum PSA was measured every 2 weeks until disease progression. Questionnaires were administered to assess sexual function. Results: Median follow-up is 3.9 years. At the first PSA nadir, median decrease in PSA from baseline was 96.5%. Thirty of 41 patients (73%) achieved a second PSA nadir and median decrease of 98.5% from baseline. Median time to each nadir was 3.7 and 5.8 weeks, respectively. Median time to treatment failure was 21.3 months. Toxicities were minor, including gynecomastia. Seventeen of 29 (59%) and 12 of 24 (50%) men had normal sex drive at baseline and at second PSA nadir, respectively. One-third of men had spontaneous erection at both time points. Conclusion: Finasteride provides additional intracellular androgen blockade when added to bicalutamide. Duration of control is comparable to castration, with preserved sexual function in some patients. © 2004 European Society for Medical Oncology.

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Tay, M. H., Kaufman, D. S., Regan, M. M., Leibowitz, S. B., George, D. J., Febbo, P. G., … Oh, W. K. (2004). Finasteride and bicalutamide as primary hormonal therapy in patients with advanced adenocarcinoma of the prostate. Annals of Oncology, 15(6), 974–978. https://doi.org/10.1093/annonc/mdh221

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