title: Controversies surrounding androgen deprivation for prostate cancer.
abstract: BACKGROUND
  Management of metastatic prostate cancer continues to evolve. The widespread use of the prostate-specific antigen (PSA) assay has led to earlier diagnosis and earlier detection of recurrent disease. Debates continue regarding the proper use and timing of endocrine therapy with orchiectomy, estrogen agonists, luteinizing hormone-releasing hormone (LHRH) analogs, LHRH antagonists, and androgen antagonists.
  
  
  METHODS
  The authors reviewed the significant published materials of the last 20 years that have shaped hormonal management of metastatic and progressive prostate cancer. Major areas of controversy were also identified.
  
  
  RESULTS
  The present approach to hormonal management is summarized. Five potential pathways to the development of androgen-independent prostate cancer are described. Controversial topics of hormonal management, including immediate vs delayed hormonal therapy, monotherapy vs maximal androgen blockade (MAB), and intermittent hormonal therapy, are discussed.
  
  
  CONCLUSIONS
  Orchiectomy, estrogen agonists, and LHRH analogs have therapeutic equivalence. Patients who have a rising PSA after definitive treatment for prostate cancer and high risk of recurrent disease may warrant early androgen deprivation. MAB does not appear to be significantly better than single-agent LHRH analog therapy. Intermittent therapy may delay emergence of androgen independence and maintain or improve quality of life.
authors.affiliation: Genitourinary Oncology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA. pattersg@moffitt.usf.edu
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Patterson
authors.forename: Lodovico
authors.initials: L
authors.lastname: Balducci
authors.forename: Julio M
authors.initials: JM
authors.lastname: Pow-Sang
mesh_terms: D000726:Androgen Antagonists / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D004967:Estrogens / Q000819:agonists; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists / Q000037:antagonists & inhibitors; D006801:Humans; D008297:Male; D009919:Orchiectomy / Q000523:psychology; D011471:Prostatic Neoplasms / Q000523:psychology / Q000628:therapy*; D013997:Time Factors
chemical_list: D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D004967:Estrogens; D007987:Gonadotropin-Releasing Hormone