Drug therapy of prostatic cancer

While hormonal therapy has been the usual and appropriate treatment of advanced or metastatic prostatic cancer for the past 50 years, the recent development of new therapeutic agents as medical alternatives to orchidectomy has drastically altered the options and perspectives in the treatment of this disease. Estrogens had been the only commonly used drug therapy in the United States. Newer alternatives include androgen synthesis inhibitors, a class of agents termed antiandrogens, and gonadotrophin-releasing hormone (GnRH) [luteinising hormone-releasing hormone (LHRH)] analogues, either alone or in combination. As the result of basic scientific studies and prospective clinical trials which have examined the issue of risk versus benefit, several trends have emerged. In the United States, orchidectomy is waning as the primary treatment option for metastatic prostatic cancer, while estrogen use has declined drastically; GnRH analogues are being prescribed more frequently. Furthermore, combination therapy with GnRH analogues (or orchidectomy, to a lesser extent) and the antiandrogen flutamide is gaining wider acceptance as a primary treatment option. The rationale, advantages, and real or potential disadvantages of these various treatment options are discussed.