For most men with locally advanced prostate cancer, hormone therapy started immediately after diagnosis significantly reduces tumour progression and delays metastases. But the degree of benefit in different patients is still to be defined.(2),(3)
For many men with locally advanced disease, hormone therapy alone is enough to control the disease for many years. It may be the treatment of choice for many elderly men.
Studies have shown little difference in efficacy between surgical castration and LHRH analogues and between LHRH analogues and the anti-androgen drug bicalutamide (Casodex).
The advantage of bilateral orchidectomy is that it is a one-off treatment while the disadvantage is that it is irreversible. Many men find it unacceptable as it has negative psychological effects.
LHRH analogues are often the chosen form of hormonal therapy. Their side effects include lethargy, hot flushes, weight gain and loss of sexual function. Long term use affects bone density and is linked with an increased risk of fracture.
Some men may choose anti-androgens (bicalutamide) instead of an LHRH analogue because it offers them the possibility of remaining sexually active. The main side effects of bicalutamide are breast enlargement (gynaecomastia) and breast pain.