ADVANCES AND TRENDS IN HORMONAL-THERAPY FOR ADVANCED PROSTATE-CANCER

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.