Is there an alternative to LHRH drugs for shrinking the prostate gland before brachytherapy?

Rather than using the standard LHRH agonists drugs to suppress testosterone production and shrink the prostate gland before brachytherapy, this group of researchers tested out using the 5-alpha-reductase inhibitor Dutasteride (Avodart) in combination with the anti-androgen Bicalutamide (Casodex). This was a small study; i.e., just 31 patients got the LHRH drugs and 29 got the experimental combination. There was no significant differences in terms of shrinking the gland between the two groups or serious side effects. However the men getting Dutasteride plus Bicalutimide had significantly better sexual function and less sexual bother, as assessed by a questionnaire called EPIC at six months than the men getting the LHRH drugs at six months. Unfortunately, that advantage was not maintained past one year. In sum, the dutasteride + bicalutamide combination may eventually be shown to be a good alternative to the LHRH drugs for men going on ADT short term. 


Gaudet M, Vigneault E, Foster W, Meyer F, Martin AG. 2015. Randomized non-inferiority trial of Bicalutamide and Dutasteride versus LHRH agonists for prostate volume reduction prior to I-125 permanent implant brachytherapy for prostate cancer. Radiother Oncol 118(1):141-147.