Immediate versus deferred treatment for advanced disease.

The timing of hormonal treatment has been controversial for the last 50 years. The VACURG studies suggested that deferring treatment in symptom free patients might not compromise survival. Recent studies of maximal androgen blockade have revived an old observation that disease presenting earlier may be more hormone sensitive. The arguments in favour of immediate versus deferred treatment depend on the balance of advantages against side effects and costs, but a clear advantage in terms of survival from immediate treatment has yet to be demonstrated. An MRC study of this issue has recruited 1938 patients and should make it first report in 1996. Meanwhile, in many men, deferred treatment remains a valid management option, provided it is used with caution and careful follow-up.