Treatment of Prostate Cancer—The Role of Primary Hormonal Therapy

Abstract

Prostate cancer is a sex hormone-responsive tumour. Hormonal manipulation is therefore the prime therapeutic strategy for patients in whom the disease is not considered curable with local radical therapy. Several different hormonal therapies, which act by different mechanisms, are available: bilateral orchidectomy (surgical castration), oestrogens, luteinising hormone-releasing hormone (LHRH) agonists, antiandrogens, and LHRH antagonists. This article discusses the pharmacology, tolerability, and administration of these therapies and their efficacy as monotherapy or as neoadjuvant or adjuvant therapy, across the progressive stages of prostate cancer. Current evidence favours the immediate initiation of hormonal therapy but decisions on timing and the type of hormonal therapy should be made together with the patient who should be provided with full information about each of the available options including efficacy and impact on quality of life.