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So called combined androgen blockade (CAB), or maximum androgen blockade (MAB), has been used worldwide. CAB has established clinical superiority to androgen deprivation monotherapy in survival rates among metastatic prostate cancer patients from meta-analyses data series. However, there is not such a big difference in survival between CAB and androgen deprivation monotherapy. Recently, Fujii et al. (BJU International, 97: 1184–89, 2006) reported that so called delayed or deferred CAB with bicalutamide was effective in patients with progression during androgen deprivation monotherapy, and suggested the clinical usefulness of biopsy Gleason score and PSA doubling time as predictors for the response of delayed or deferred CAB. However, we have no answer to the clinical question: ‘Who should be treated by CAB?’

In the current issue of International Journal of Urology, Soga et al. undertook to find predictors to identify the population who should be treated by CAB and proposed one attractive algorithm model. Unfortunately, because the population analyzed in their article was small and very heterogeneous, we should validate the potential model carefully. However, the editor believes that their attempt is a fruitful work to solve an important problem in the hormonal management of prostate cancer. Again, ‘Who should be treated by CAB?’ Future study should be carried out to address this critical question.