The timing of hormone therapy for men with asymptomatic advanced prostate cancer.

The most appropriate time to introduce hormonal therapy for patients with advanced prostate cancer is a contentious issue. Recent prospective studies comparing immediate and deferred hormonal therapy (medical or surgical castration) on survival outcome are reviewed with the aim of redefining the most appropriate time to initiate hormonal therapy for individual patients. The evidence supports the use of immediate hormonal therapy in previously untreated patients with advanced disease (M1) and also the use of adjuvant hormonal therapy after radical prostatectomy and lymphadenectomy for node-positive (but clinically localized) disease. Immediate hormonal therapy may also be advantageous in advanced local/regional disease when it is the primary treatment contemplated (i.e., without any definitive curative therapy to the prostate), although not all studies show this. Adjuvant hormonal therapy has significantly improved survival in some studies in the radiotherapy setting; the lack of statistically significant benefits in other studies may be a result of the timing of hormonal therapy in relation to the administration of external beam irradiation. Decisions on the immediate initiation of hormonal therapy should also take into account the patient's life expectancy and the side effects and long-term complications of androgen deprivation therapy. Recent epidemiological studies indicate that prostate cancer mortality has fallen in the USA. This decline in prostate cancer mortality is likely to be multifactorial with early application of hormonal therapy being one potential contributory factor. It is recommended that after an assessment of their disease risk, patients should be informed about the benefits and side effects of all potential treatment options and allowed to make an informed choice about their treatment.