Anti-androgenic effects of combination finasteride plus flutamide in patients with prostatic carcinoma

Objectives To determine the anti-androgenic effects and safety of the combination of finasteride and flutamide in men with prostate cancer. Patients and methods Seventeen men with various stages of prostate cancer, all of whom were candidates for androgen deprivation therapy, were treated with finasteride plus flutamide and were followed for a mean of 13.6 months using measurements of serum prostate specific antigen (PSA), and an assessment of regression and side-effects. Results The initial median PSA level was 19.8 ng/mL: at 3, 6 and 12 months the median PSA had fallen to 1.2, 0.85 and 0.8 ng/mL, respectively. In four patients followed for 2 years, the anti-neoplastic effects were sustained. Patients with initially palpable disease had regression, as assessed by a digital rectal examination. Side-effects included gynaecomastia (five patients), mildly elevated hepatic transaminases (two) and diarrhoea (one). Most (10) men maintained their previous sexual function. Conclusions Early results suggest that the combination of finasteride and flutamide provides significant antiandrogenic therapy and maintains sexual function in most men. A further investigation with more patients and a longer follow-up is warranted.