Luteinizing hormone-releasing hormone monotherapy: A viable option for treatment of prostate cancer?

When addressing the appropriateness of luteinizing hormone-releasing hormon e (LHRH) analog monotherapy as a method of androgen deprivation, it is impo rtant to look at the alternative option of androgen deprivation by combined androgen blockade (CAB). The randomized control trials studying CAB have b een thoroughly analyzed and subjected to meta-analyses that have shown a sm all but significant difference in survival at 5 years. These findings have been subject to variable interpretations. Much like other treatment-option decisions for prostate cancer, it is mandatory to inform patients fully on the costs and benefits of monotherapy versus CAB and to incorporate the pat ient's concerns and preferences in the decision-making process. Currently, parameters to identify a subgroup of patients who might specifically benefi t from a combined androgen deprivation treatment policy are not available. When using monotherapy, it is necessary to recognize several important fact s. Castrate testosterone levels are not achieved or maintained in all patie nts. For some patients this may be a disadvantage. Additionally, before cat egorizing a patient as having an androgen-independent tumor, it is importan t to measure serum testosterone to ensure that LHRH analog monotherapy has achieved and maintained a castrate testosterone level. (C) 2001, Elsevier S cience Inc.