Recent advances in hormonal therapy for advanced prostate cancer.

Hormonal treatment of advanced prostate cancer should be considered for patients who have stages C and D1 disease, a high risk of recurrence after local therapy, or prostate-specific antigen-measured recurrence after local treatment. This approach is dependent on most prostate cancer cells being androgen-dependent, but androgen-independent cells may arise after several years of hormonal therapy. Options for androgen blockade primarily include orchiectomy, luteinizing hormone-releasing agonists and antagonists, and nonsteroidal antiandrogens. There is some controversy regarding combined androgen blockade, intermittent androgen blockade, and the question of whether early androgen blockade is superior to delayed therapy. Convincing data do exist for the use of adjuvant/neoadjuvant hormonal therapy with external-beam radiation therapy. Although hormonal therapy is an important treatment modality for advanced prostate cancer, long-term treatment carries significant side effects that need to be considered.