In a comparative analysis of 29 studies, maximal androgen deprivation
(MAD) was not found to be superior to partial androgen deprivation. Th
us, MAD cannot be regarded as the new gold standard. Most trials focus
on quality of life which - given the palliative aim of the treatment
- deserves special attention. This aspect has not yet been evaluated,
however, in the largest multicenter study, Intergroup study 0105. In p
atients with advanced bone metastasis or severe pain, MAD treatment sh
ould be begun because of the flare phenomenon. The synergistic effects
of LHRH agonists on the prostate are currently being investigated. Si
nce no clear prognostic factors exist and reduction of serum-PSA level
s under MAD does not delay progression, the patient must help to make
the decision of whether or not MAD should be begun.