Combined androgen blockade (CAB) versus luteinizing hormone-releasing hormone (LHRH) agonist monotherapy for androgen deprivation therapy

  • Hyun Sik Park
  • Hyun Bin Shin
  • Seung Hyo Woo
  • Seung Hyun Jeon
  • Sang Hyub Lee
  • Seok Ho Kang
  • Ji Sung Shim
  • Dong Wook Shin
  • Jinsung ParkEmail author
Original Article



Combined androgen blockade (CAB) and luteinizing hormone-releasing hormone (LHRH) agonist monotherapy are commonly used in androgen deprivation therapy (ADT). In this randomized clinical trial, we aimed to compare the two methods of ADT in terms of quality of life (QOL).


Eighty patients who underwent primary ADT for newly diagnosed prostate cancer were randomly assigned to CAB group (Group 1) and LHRH agonist monotherapy group (Group 2). Leuprolide and anti-androgen (bicalutamide 50 mg) were used to minimize the confounding effects caused by medication. QOL was evaluated at baseline, 3 months and 6 months post-ADT using validated EORTC QLQ-C30, PR25, and depression questionnaires. A difference of > 10 points in the EORTC domain scores was defined as ‘clinically significant’.


In the baseline characteristics, there was no significant difference between the two groups. At 3 months after ADT, Group 1 had significantly lower pain scores than Group 2 (p = 0.004), while Group 1 had significantly poorer diarrhea symptom score than Group 2, without clinical significance (p = 0.047). No significant differences were observed in the C30, PR25 domains, and the depression score at 3 months. At 6 months, the QOL scores of all the groups were similar.


There was no difference in the patient’s QOL, except that CAB group was associated with significantly better pain relief than LHRH agonist monotherapy at 3 months following ADT, which was not sustained thereafter. Our results suggest that the benefit of prolonged (≥ 3 months) CAB is questionable in terms of patients’ QOL.


Prostate cancer Androgen deprivation therapy Combined androgen blockade Luteinizing hormone-releasing hormone agonist Quality of life 



This study was supported by DAEWOONG Pharm, Co. Research Grant.

Author contributions

HSP data analysis, manuscript writing/editing. HBS data analysis, manuscript writing/editing. SHW data collection. SHJ data collection. SHL data collection. SHK data collection. JSS data collection. DWS data collection, data analysis. JP project development, data collection, data analysis, manuscript writing/editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interests.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Institutional Review Board of the Eulji University Hospital (No. 2014-03-011).

Informed consent

A written informed consent was obtained from each patient before screening.

Supplementary material

345_2019_2847_MOESM1_ESM.tif (19.4 mb)
Supplementary material 1 (TIFF 19875 kb) Supplementary Figure S1. Study design
345_2019_2847_MOESM2_ESM.tif (11.8 mb)
Supplementary material 2 (TIFF 12032 kb) Supplementary Figure S2. Patient disposition and study flow
345_2019_2847_MOESM3_ESM.tif (2.7 mb)
Supplementary material 3 (TIFF 2743 kb) Supplementary Figure S3. Changes in hormonal treatment-related symptom according to ADT method


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Urology, Eulji University HospitalEulji University School of MedicineDaejeonSouth Korea
  2. 2.Department of UrologyKyung Hee University School of MedicineSeoulSouth Korea
  3. 3.Department of UrologyKorea University College of MedicineSeoulSouth Korea
  4. 4.Department of Family MedicineSamsung Medical CenterSeoulSouth Korea

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