Hematology & Oncology

A dramatic, objective antiandrogen withdrawal response

Tuesday, 26 April 2011 10:25
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Antiandrogen withdrawal response is an increasingly recognized entity in patients with metastatic prostate cancer. To our knowledge, there have been no reports describing a durable radiologic improvement along with prostate-specific antigen (PSA) with discontinuation of the antiandrogen agent bicalutamide. We report a case in which a dramatic decline of serum PSA levels associated with a dramatic improvement in radiologic disease was achieved with bicalutamide discontinuation.



Cancer of the prostate is the most prevalent cancer of American men [1]. At the time of diagnosis almost 50% of the patients have disease that extends beyond the prostate gland. Disseminated prostate cancer is primarily treated by local palliative measures and by testicular androgen ablation (medical or surgical). Non-steroidal antiandrogens are commonly used – either as short-term induction therapy to blunt the surge of testosterone that follows the initiation of luteinizing hormone-releasing hormone (LHRH) analogues, as long-term therapy with LHRH analogues or as single agent salvage treatment in men in whom LHRH analogues or surgical castration have ceased to control the disease. A phenomenon referred to as the antiandrogen withdrawal syndrome or antiandrogen withdrawal response (AAWR) occurring in men receiving non-steroidal antiandrogens was first described in 1993 [2-4]. The AAWR is defined as a 50% decline in prostate specific antigen (PSA) following cessation of an antiandrogen. The pathophysiology of the phenomenon is not completely understood. We report a very dramatic and prolonged antiandrogen withdrawal response and discuss the literature and recent information regarding the pathophysiology of the AAWR.

Last Updated on Tuesday, 26 April 2011 10:55