In this retrospective study, we evaluated and compared the efficacy and toxicities of maximal
androgen blockade (MAB) versus
castration alone in Chinese patients with advanced
prostate cancer. From 1996 to 2004, 608 patients with advanced
prostate cancer were included in the study. Patients were retrospectively divided into two groups according to different therapeutic regimens. Of the 608 patients, 300 patients were treated with MAB (
castration plus
nonsteroidal antiandrogens) and the remaining 308 were treated with
castration alone. The 2- and 5-year overall survival rates of these patients were 73.7% and 56%, respectively. Multivariate analysis showed that, in patients with metastatic
prostate cancer, MAB was associated with not only the improvement of progression-free survival (PFS) (increased by 10 months) but also a 20.6% reduction in mortality risk compared with
castration alone. In contrast, the efficacy of MAB was not superior to
castration alone for patients with nonmetastatic
prostate cancer. Interestingly, among patients with MAB, those using
bicalutamide had a longer PFS than those using
flutamide; this was especially so in patients with metastatic
prostate cancer. Almost all of the toxicities due to the
hormone therapy were mild to moderate and manageable. To conclude, in China,
hormone therapies, including MAB and
castration alone, have been standard treatments for advanced
prostate cancer. For patients with nonmetastatic
prostate cancer,
castration alone might be adequately practical and efficient. In patients with metastatic
prostate cancer, however, MAB has superior efficacy over
castration alone. It is clear that MAB should be considered the first-line standard treatment for patients with metastatic
prostate cancer.