Physiologic basis of endocrine therapy for prostatic cancer

Advances in our understanding of hypothalamic-pituitary gonadal regulation have led to the development of pharmaceutical agents that produce a medically castrate state with minimal morbidity. The selection of the method for androgen ablation in a given patient with stage D adenocarcinoma of the prostate should be based on patient preference and on cost, because the therapeutic outcomes of medical castration and orchiectomy are equivalent. The addition of androgen receptor antagonists to a given patient's regimen should be made with the knowledge that the impact on the mortality rate is modest and the cost significant. Further manipulation of androgen production or action in patients with hormonally resistant cancer is unlikely to improve either the disease progression or the mortality rate. Research efforts should be focused on the development of effective chemotherapy for such disease.