Editing Hormonal Therapy (section)

== Combination therapy ==

* '''ADT with Radical Prostatectomy'''
** See '''Management of Locally Advanced Prostate Cancer''' Notes
* '''ADT with Radiation Therapy'''
** See '''Management of Locally Advanced Prostate Cancer''' Notes
* '''Combined androgen blockade (CAB)'''
** The term CAB is preferred over “total androgen blockade” or “maximum androgen blockade” since it is unknown what defines "total" or "maximum" blockade
** '''The concept of combining an anti-androgen to surgical or medical (LHRH analogue) castration is based on the idea that, after the elimination of testicular androgens through surgical or medical castration, adrenal androgens still contribute to prostate cancer progression'''
*** The anti-androgens are nonspecific in blocking the binding of androgens to the AR: both testicular and adrenal androgens are affected.
** '''In a''' '''meta-analysis''' of 27 studies '''comparing CAB to standard ADT, there was no significant difference in 5-year survival''' (CAB 25.4% vs. 23.6% standard ADT).
*** Studies including the steroidal antiandrogen cyproterone acetate had a slightly worse outcome on the CAB arms (5-year survival 15.4% vs. 18.1% for ADT alone), suggesting increased non–prostate cancer deaths in those receiving cyproterone acetate.
*** When '''studies examining the outcomes of the non-steroidal antiandrogens''' flutamide or nilutamide were considered independent of those with cyproterone acetate, '''the 5-year survival improved significantly in the CAB arms by 3%''' (95% CI 0-5%) (27.6% with CAB vs. 24.7% for ADT)