MDT (multi-disciplinary team) guidance for managing prostate cancer

Second- or third-line hormone therapy
• Some patients will respond to second-line hormone therapy (CAB with the addition of an antiandrogen,
anti-androgen withdrawal, diethylstilboestrol [DES]). Anti-androgen withdrawal
responses are seen in approximately 25% of cases who have been treated with first-line CAB
or have had substantial (>1 year response) to second-line CAB.
• A common second-line treatment is the addition of an anti-androgen. A retrospective analysis
of 122 patients who received the addition of bicalutamide 50 mg to goserelin for PSA and clinical
progression showed a >50% decrease in PSA concentration in 30% of patients (responders) and
a reduction in PSA concentration in 75% of all patients. The median duration of response from
start of bicalutamide 50 mg was 291 days for responders and 193 days for the population as a
whole. Those patients with a short duration of response to goserelin monotherapy (