Combined androgen blockade is the treatment of choice for patients with advanced prostate cancer: the argument against.

The concept that patients with advanced prostate cancer will survive longer if treated by a combination of castration and the blockade of androgens of non-testicular origin cannot be substantiated. When all of the available studies are reviewed, meta-analysis does not show any significant improvement in mortality when the combined approach is used. Some studies have suggested that combined treatment is particularly useful in patients with minimal disease, or with a good prognosis; it must be remembered that these are smaller groups which have been taken from large numbers of patients in which the endpoint was observations on the larger group and not the small subgroup.