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Definition |
There are conflicting results from the many studies comparing CAB with monotherapy. The largest RCT in 1,286 M1b patients found no difference between surgical castration plus flutamide compared to surgical castration without flutamide. Systematic reviews have shown that CAB using non-steroidal anti-androgen (NSAA) appears to provide a small survival advantage (< 5%) vs. monotherapy (surgical castration or LHRH agonists) beyond 5 years. However, some of the larger trials included in these reviews were methodologically flawed and it is unlikely that this small advantage, if any, is useful in daily clinical practice. LHRH analogues and NSAA have the highest estimated quality-adjusted survival. However, the use of CAB increases side effects and the economic cost. There is an incremental cost of more than US$1 million per quality-adjusted life-year vs. orchiectomy alone.
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