Is prednisolone as good as flutamide in hormone refractory metastatic carcinoma of the prostate?
OBJECTIVE
There are no generally accepted rules for the second line treatment of prostate cancer and few prospective studies have attempted to compare 2 therapeutic strategies with different modes of action.


METHODS
We describe a prospective, randomized study of 40 patients comparing the second line response of flutamide to prednisolone in patients with known hormone refractory stage M1 prostate cancer.


RESULTS
The median survival of patients receiving either treatment was 32.9 weeks, with no difference between the 2 groups. In terms of biological response 11 of 20 patients (55%) receiving prednisolone and 10 of 20 (50%) receiving flutamide exhibited prostate specific antigen (PSA) suppression. Average minimum PSA was 54 and 52% of the initial PSA in patients receiving prednisolone and flutamide, respectively. There was no difference between the 2 treatment groups in terms of long-term survival, although 35% of all patients survived beyond 1 year and 3 survived beyond 2 years.


CONCLUSIONS
More patients taking prednisolone described better pain relief, although both medications were well tolerated and there was no difference in terms of performance status or analgesic requirements.
Datta
S N
SN
Department of Urology, University Hospital of Wales, Health Park, Cardiff, United Kingdom.
Thomas
K
K
Matthews
P N
PN
D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D005485:Flutamide / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D010865:Pilot Projects; D011239:Prednisolone / Q000627:therapeutic use*; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D015996:Survival Rate
D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D005485:Flutamide; D011239:Prednisolone