Maximal androgen blockade (MAB) using leuprorelin or goserelin plus flutamide provides a significant survival advantage in patients with D2 prostate cancer. It is noteworthy that in a nonconcurrent comparison leuprorelin plus flutamide was more effective than leuprorelin plus nilutamide. The benefits of leuprorelin plus flutamide outweigh the side effects and costs of patients with bone metastases limited to the axial skeleton have a significantly prolonged time to progression and survival. Novel indications of MAB are neoadjuvant and adjuvant therapies. However, a final benefit assessment is not possible at the present time. The side effects of MAB can be minimized when given intermittently. Studies to test its effectiveness have been initiated.
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