ABSTRACT
Endocrine treatment remains the most effective therapy for advanced prostate cancer1. Evidence is accruing for benefit from earlier use2-3. In patients presenting in the traditional manner with bone metastases or substantial local disease, the main consideration has been immediate toxicity. Now, earlier diagnosis has identified men either at presentation, or following failure of curative treatment, in whom endocrine treatment may be considered when survival for many years is likely4. Not only are such patients liable to the immediate sideeffects of treatment for longer, they may also be of an age when loss of libido is less tolerable. In addition, if hormone treatment is administered for many years, long-term complications become a significant issue. Alternative methods of hormone treatment may avoid some of the hazards associated with traditional androgen deprivation by medical or surgical castration. There is renewed interest in estrogen therapy as a method of avoiding problems with steroid deficiency5. New hormone treatment strategies-treatment escalation and intermittent therapy-are also proposed to avoid toxicity. Optimum treatment remains a balance between survival and the reduction of the adverse effects of the disease, on the one hand, and the quality-of-life deficit from its side-effects, on the other6.
