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The prostate cancer treatment that
merges castration with anti-androgens is called combined androgen
blockade (CAB).
The use of anti-androgens a few weeks before LHRH
agonists are started has been shown to significantly
reduce the incidence of hormone
flare that can be painfully dangerous for patients
with distant bone metastasis.
Anti-androgens can also
be used after surgical or medical castration stops being
effective. There is some controversy surrounding whether
or not combined androgen blockade is more effective
than using either an anti-androgen or a form of castration
for the treatment of prostate cancer. There are a few
studies that indicate using anti-androgens as monotherapy
may be slightly less effective than medical or surgical
castration as monotherapy. Other studies found no difference
in the survival rates of people who had used only one
form of treatment.
When using monotherapy, such as only chemical castration, a patient will not necessarily experience all the possible side effects. In combination with an anti- androgen, however, the chance of experiencing more side effects and more severe side effects is dramatically increased.
The data supporting the use of combine androgen blockade is controversial, so patients who wish to avoid the many side effects associated with combined androgen blockade, may first wish to consider monotherapy. The use of an anti-androgen a few weeks before beginning the LHRH agonist, continues to be an effective therapy for patients who need to avoid hormone flare.
Some common side effects of surgical and medical castration include:
- gynecomastia (tenderness and growth of the breasts)
- a general increase of body fat
- a decrease of muscle mass
- hot flashes
- trouble sleeping or insomnia
- osteoporosis
- fatigue
- depression
- dizziness and headaches
- impotence or decreased desire for sex
- disturbances in vision
For a full listing of the side effects associated with surgical castration and medical castration, please see the other Hormone Therapy Side Effects Sections.
Some common side effects that are associated with the use of anti-androgens include:
- urinary side effects
- decreased desire for sex
- gynecomastia (tenderness and swelling of the breasts)
- constipation or diarrhea
- flu-like symptoms (including headache, muscle and joint pain, fatigue, nausea and vomiting)
- vision disturbances
- urinary side effects
For a full listing of all the side
effects associated with the use of an anti-androgens,
please see the Prostate Hormone Therapy Side Effects
– Anti-androgens section which will contain
a full listing of the associated side effects.
Patients may experience side effects that are not listed in the Prostate Cancer Treatment Guide. Patients who are using combine androgen blockade as their prostate cancer should be alert for any side effects that could be attributed to hormone therapy. Patients who are interested in starting combined androgen should speak to their doctors or a prostate cancer nursing specialist about whether combined androgen blockade is the right choice for their prostate cancer treatment.
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