Hormone therapy for prostate cancer - immediate initiation

Although hormone therapy is widely used in the management of prostate cancer, the optimal timing of its initiation remains a matter of debate. Many studies of the last decades have reported a small but significant survival benefit and a clear delay in the development of clinical symptoms after early initiation of therapy. Patients who have localized or locally advanced prostate cancer and are not suitable for curative options like radical prostatectomy or radiotherapy can best be managed by hormone therapy alone, which has already been recognized as the optimal treatment for metastatic disease. On the other hand, long-term hormone treatment will expose the patient to the risk of substantial adverse effects, including muscle wasting, chronic fatigue and osteoporosis. Prognostic and quality-of-life factors also have an impact on the treatment decision, particularly in patients most likely to profit from an extension of the remaining life span. Based on available evidence, early hormone therapy may be recommended for men with poorly differentiated tumors or advanced disease and for those infrequently seen by their physicians. This management can prevent prostate cancer from migrating to the bones, where treatment becomes extremely difficult and cure or even longterm control of the disease is an exception.