Advances and trends in hormonal therapy for advanced prostate cancer

Hormonal therapy represents first-line treatment for patients with advanced prostate cancer. Generally, surgical castration is viewed as the 'gold standard' but carries with it a psychological effect. Medical alternatives include LHRH analogues, antiandrogens, and oestrogens, though the last of these is associated with cardiovascular problems. For complete androgen ablation, it is generally believed that androgens of both testicular and adrenal origin need to be blocked. Combined androgen blockade (CAB) by the addition of antiandrogen to castration (medical or surgical) may, therefore, be an appropriate treatment for advanced prostate cancer. Recent trials have shown that CAB may have treatment advantages compared with castration alone, and these benefits are greatest in patients with minimal metastatic disease. For these patients CAB may now be considered as standard therapy. In the treatment of non-metastatic disease, recent trends based on the experience gained in advanced prostate cancer include the possible use of hormonal therapy in neoadjuvant and adjuvant settings along with prostatectomy or radiotherapy. There is also growing interest in the use of intermittent rather than continuous hormonal therapy. New treatments offer an increasing range of management options to help improve the quality of life of prostate cancer patients.