title: Maximal androgen blockade for advanced prostate cancer.
abstract: OBJECTIVE
  This systematic review assessed the effect of maximal androgen blockade (MAB) on survival when compared to castration (medical or surgical) alone for patients with advanced prostate cancer.
  
  
  METHODS
  Randomized controlled trials were searched in general and specialized databases (MEDLINE, EMBASE, Cancerlit, Cochrane Library, VA Cochrane Prostate Disease register) and by reviewing bibliographies.
  
  
  METHODS
  All published randomized trials were eligible for inclusion provided they (1) randomized men with advanced prostate cancer to receive a non-steroidal anti-androgen (NSAA) medication in addition to castration (medical or surgical) or to castration alone, and (2) reported overall survival, progression-free survival, cancer-specific survival, and/or adverse events. Eligibility was assessed by two independent reviewers.
  
  
  METHODS
  Information on patients, interventions, and outcomes were extracted by two independent reviewers using a standardized form. The main outcome measure for comparing effectiveness was overall survival at 1, 2, and 5 years. Secondary outcome measures included progression-free survival and cancer-specific survival. The relationship of specific NSAA on outcome was evaluated. Additionally, the incidence of adverse effects was measured.
  
  
  RESULTS
  Twenty trials enrolling 6,320 patients were included. The pooled OR for overall survival was 1.03 (95% CI:0.85 to 1.25), 1.16 (95% CI:1.00 to 1.33), and 1.29 (95% CI:1.11 to 1.50) at 1, 2, and 5 years respectively. Overall survival was only significant at 5 years. The risk difference at 5 years was 0.048 (95% CI:0.02 to 0.077) and NNT at 5 years 20.8. Progression-free survival was improved only at 1 year follow-up (OR=1.38) and cancer-free survival was improved only at 5 years (OR=1.22). Adverse events occurred more frequently in those assigned to MAB and resulted in withdrawal in 10%. Quality of life was measured in only one study favored orchiectomy alone (less diarrhea and better emotional functioning in the first 6 months).
  
  
  CONCLUSIONS
  MAB produces a modest overall and cancer-specific survival at 5 years but is associated with increased adverse events and reduced quality of life.
authors.affiliation: Health Services Research & Development Program, VA Chicago Health Care System-Lakeside Division, 333 E. Huron Street, Chicago, Illinois 60611, USA. Cbenne@nwu.edu
authors.forename: B
authors.initials: B
authors.lastname: Schmitt
authors.forename: C
authors.initials: C
authors.lastname: Bennett
authors.forename: J
authors.initials: J
authors.lastname: Seidenfeld
authors.forename: D
authors.initials: D
authors.lastname: Samson
authors.forename: T
authors.initials: T
authors.lastname: Wilt
mesh_terms: D000726:Androgen Antagonists / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D008297:Male; D009376:Neoplasms, Hormone-Dependent / Q000628:therapy*; D009919:Orchiectomy; D011471:Prostatic Neoplasms / Q000628:therapy*
chemical_list: D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D007987:Gonadotropin-Releasing Hormone