Hormonal therapy represents first-line treatment for patients with adv
anced prostate cancer. Generally, surgical castration is viewed as the
'gold standard' but carries with it a psychological effect. Medical a
lternatives include LHRH analogues, antiandrogens, and oestrogens, tho
ugh 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 andro
gen blockade (CAB) by the addition of antiandrogen to castration (medi
cal or surgical) may, therefore, be an appropriate treatment for advan
ced prostate cancer. Recent trials have shown that CAB may have treatm
ent advantages compared with castration alone, and these benefits are
greatest in patients with minimal metastatic disease. For these patien
ts CAB may now be considered as standard therapy. In the treatment of
non-metastatic disease, recent trends based on the experience gained i
n advanced prostate cancer include the possible use of hormonal therap
y in neoadjuvant and adjuvant settings along with prostatectomy or rad
iotherapy. There is also growing interest in the use of intermittent r
ather than continuous hormonal. therapy. New treatments offer an incre
asing range of management options to help improve the quality of life
of prostate cancer patients.