[Conservative therapy of prostate cancer]

Treatment of carcinoma of the prostate with hormones can be carried out as partial or complete androgen deprivation. As primary therapy it may be administered palliatively in advanced carcinomas (almost always metastatic), as adjuvant treatment following radical prostatectomy, as "salvage" treatment in post-irradiation recurrent disease, or secondarily after unsuccessful primary treatment. In the case of primary treatment, androgen deprivation is more effective than chemotherapy (NPCP Protocol 1300). LHRH analogues (of the gosereline acetate type) are equally as effective as orchiectomy (standard therapy), but cause a flare-up of the patient's symptoms within the first two weeks, and are therefore given in combination with an antiandrogen. The use of a pure antiandrogen (of the flutamide type) is equally as effective as the standard therapy, but in contrast to the latter, impotence does not occur. Complete androgen deprivation (LHRH analogues plus pure antiandrogens) is more effective in the case of low-volume metastases--in terms of time-to-progression--than standard therapy.