[Problems and principles of hormone therapy of advanced prostate cancer]

The availability of hormones with few side effects has enlarged the indication for their use: In the presence of metastases, primary endocrine treatment which includes orchiectomy as standard therapy is employed with palliative intent. Adjuvant endocrine treatment is given after radical prostatectomy when positive margins or lymph nodes were present. A salvage endocrine treatment is administered if the primary tumor persists after radiotherapy or recurred after prostatectomy. The term diagnostic hormone treatment is misleading and should not be used. A secondary hormone application is supported by the observation that allaged hormone resistant tumor progressed after testosterone injection. The problem of early versus delayed endocrine therapy is unsolved, however, it is conceivable that the latter therapy is confronted with a larger tumor burden. The principle of endocrine treatment is properly described as means suppressing the androgenic stimuli. There are 5 different routes of androgen deprivation, among which the antiandrogens and LH RH analogs have the highest priority. Phase III-studies are under way to clarify their efficacy.