Hormone therapy of advanced prostate cancer: where we stand today

Until recently, the treatment of advanced prostatic carcinoma centered around orchiectomy or estrogen administration. Now, LHRH agonists will produce anorchid levels of testosterone with fewer side effects than DES. Tumor flare associated with initial treatment has been controlled by both non-steroidal and steroidal antiandrogens. Flutamide monotherapy is an alternative for patients concerned with maintaining sexual potency, though relapse is generally refractory to conventional therapy. A recent study comparing leuprolide with and without flutamide indicates that combination therapy may, indeed, produce significant benefits, particularly in patients with minimal disease. Glucocorticoids, synthetic steroidal antiandrogens, aminoglutethimide, ketoconazole, and spironolactone also may be used to block adrenal androgens. The authors present the various options.