PMID- 12496859
OWN - NLM
STAT- Publisher
LR  - 20191120
IS  - 1476-5608 (Electronic)
IS  - 1365-7852 (Linking)
VI  - 2
IP  - 1
DP  - 1999 Jan
TI  - Maximum androgen-blockade with medical or surgical castration in advanced 
      prostate cancer: A meta-analysis of nine published randomized controlled trials 
      and 4128 patients using flutamide.
PG  - 4-8
AB  - With the recent Southwest Oncology Group (SWOG) publication of their metastatic 
      prostate cancer clinical trial results, which concluded that orchiectomy and 
      flutamide as maximal androgen blockade (MAB) therapy vs orchiectomy alone does 
      not significantly improve survival (NCI 0105), and the 1989 publication from the 
      same cooperative group indicating a 24% improvement in survival for MAB therapy 
      with leuprolide and flutamide versus leuprolide alone (NCI 0036), clinicians may 
      well be undecided about the likelihood of clinical benefits with flutamide in 
      combination with medical or surgical castration. To better characterize this 
      important therapeutic decision, we assessed the survival benefit of MAB therapy 
      with flutamide through a meta-analysis of up-to-date information from studies 
      reported/conducted from 1989 through 1998. All peer-reviewed published randomized 
      controlled trials comparing treatment with flutamide plus either lutenizing 
      hormone releasing hormone (LhRH) agonists or orchiectomy as MAB treatment with 
      LhRH or orchiectomy alone were included. The primary objective of the study was 
      to form a combined estimate and confidence interval for the hazard ratio (as 
      measured by the relative risk (RR) of survival in a comparison of castration vs 
      MAB) summarizing the effect of flutamide treatment on overall survival. Directly 
      extracted estimates of the log hazard ratio were used if available (1 study); if 
      not, either an estimate of the RR based on a reported P-value from a log rank 
      test (7 studies) or a discrete proportional hazards approximation based on 
      reconstructed annual life tables for the treatment arms (1 study) were used. Nine 
      studies with 4128 patients with advanced prostate cancer were included in these 
      analyses. Pooled estimates demonstrated a 10% improvement in overall survival 
      with flutamide as MAB therapy (relative risk (RR)=0.90, 95% Confidence 
      Interval=0.79, 1.00). The currently available updated evidence from randomized 
      trials shows a 10% benefit in overall survival with flutamide as MAB therapy in 
      comparison to conventional castration, almost identical to the estimate reported 
      in the recently published Southwest Oncology Group Study (NCI 0105).
FAU - Bennett, C L
AU  - Bennett CL
AD  - The Robert H Lurie Cancer Center, the Division of Hematology/Oncology and the 
      Institute for Health Services and Policy Research Studies, Northwestern 
      University and the Chicago VA Healthcare System/Lakeside Division, Chicago, 
      Illinois.
FAU - Tosteson, T D
AU  - Tosteson TD
FAU - Schmitt, B
AU  - Schmitt B
FAU - Weinberg, P D
AU  - Weinberg PD
FAU - Ernstoff, M S
AU  - Ernstoff MS
FAU - Ross, S D
AU  - Ross SD
LA  - eng
PT  - Journal Article
PL  - England
TA  - Prostate Cancer Prostatic Dis
JT  - Prostate cancer and prostatic diseases
JID - 9815755
EDAT- 2002/12/24 04:00
MHDA- 2002/12/24 04:00
CRDT- 2002/12/24 04:00
PHST- 1998/05/07 00:00 [received]
PHST- 1998/09/03 00:00 [revised]
PHST- 1998/09/08 00:00 [accepted]
PHST- 2002/12/24 04:00 [pubmed]
PHST- 2002/12/24 04:00 [medline]
PHST- 2002/12/24 04:00 [entrez]
AID - 4500265 [pii]
AID - 10.1038/sj.pcan.4500265 [doi]
PST - ppublish
SO  - Prostate Cancer Prostatic Dis. 1999 Jan;2(1):4-8. doi: 10.1038/sj.pcan.4500265.