Hormone Therapy for Metastatic Carcinoma of the Prostate: Where Do We Stand?

Almost 60 years after the introduction of androgen withdrawal, which includes surgical castration, for metastatic carcinoma of the prostate the question arises what have we achieved in those years? Hormone therapy is still the mainstay for metastatic carcinoma of the prostate. At the time of diagnosis, 38% of men with this tumor receive an androgen deprivation as the only form of specific treatment, in addition 20% receive androgen deprivation neoadjuvantly or adjuvantly, i.e. before or after treating the primary tumor with radical prostatectomy, definitive radiotherapy or brachytherapy. In general, any modality of endocrine manipulation is given with palliative or rarely preventive palliative intent, which describes the systemic treatment following radical prostatectomy for node-positive disease to prolong the time-to-progression. So far, the only indication of its curative potential comes from a retrospective study of the University of Connecticut and is applicable for patients with a localized carcinoma and a Gleason score between 2 and 4 (= well-differentiated).