Overview of the current status of total androgen deprivation in metastasized prostate cancer

Conclusions

Metastatic prostate cancer, the dominant malignant disease in men over the age of 50 years, is a hormone-responsive malignancy for which hormonal manipulation is the mainstay in the initial treatment. Maximal androgen deprivation, by which both testicular and adrenal androgens are blocked, certainly seems a preferential approach in patients with good prognostic characteristics such as a good performance status, asymptomatic disease with minimal metastatic involvement, low alkaline phosphatase levels at the time of diagnosis, and a rapid decrease in PSA to normal levels after the initiation of the therapy. Surgical castration, although effective, seems to be inferior to depot LHRH therapy with respect to patients' acceptance and preference. Nonsteroidal antiandrogens seem to have advantages over steroidal compounds in terms of both efficacy and side effects. The ultimate goal in the management of metastatic prostate cancer is to characterize the patients and their tumors in such a way that a more individually selected approach becomes possible. In the future this goal will be reached by the inclusion of more sophisticated molecular biological parameters in the prognostic evaluation and by newer and better forms of both hormonal and nonhormonal combination therapy that are adapted to the needs of the individual patient.