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Treatment for Stage IV Prostate cancer

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Last Modified: December 14, 2003

Dear OncoLink "Ask The Experts,"
I have been diagnosed with stage 4 prostate cancer. Is it better to start total androgen ablation right away or first just leuitinizing hormone? 

David J Vaughn, MD, Medical Director of the Abramson Family Cancer Research Institute and Associate Professor of Medicine, Hematology-Oncology at the Abramson Cancer Center of the University of Pennsylvania, responds:

In general, most believe that total androgen blockade such as luteinizing hormone-releasing hormone (LHRH) agonist plus anti-androgren therapy or orchiectomy plus anti-androgen therapy is not significantly superior to LHRH agonist monotherapy or orchiectomy monotherapy. A recent meta-analysis suggests about a 2-3% improvement in survival for total androgen blockade. One needs to balance this against the cost and toxicity of the anti-androgen, which are not negligible. The only caveat is that prior to initiating LHRH agonist therapy a period of anti-androgen blockade prevents a flare in symptoms.