When to start androgen suppression is controversial, but recent investigations have reported a slightly better survival rate when therapy is started immediately after metastatic disease is identified, compared with when symptoms from metastases begin. Orchiectomy is still widely used as a safe, cost-effective method. In the past, diethylstilbestrol was widely prescribed but its association with congestive heart failure and thromboembolism has led to a decline in its use. An antiandrogen exerts its effect by competing with the remaining androgens for the intracellular androgen receptor in the target organs. This approach improves longevity by a matter of months in selected groups of men.
Prostatic cancer is the most prevalent cancer in men and the second leading cause of cancer death.
Despite intensified efforts to improve the diagnosis and treatment of PC, the death rate has remained unchanged for decades. While it is hoped that new screening approaches, including PSA testing, and increased use of radical prostatectomy will drop the death rate, the impact of these approaches on survival will not be known for another 10-15 years. A large scale prospective clinical trial is necessary to decide the relative benefits of potentially curative treatment such as radical prostatectomy and radiation therapy versus observation. Plans for such trials are now underway. Unfortunately there has been little progress in the area of treatment of metastatic disease since then, although the concept of total androgen blockade using an androgen receptor blocker has imparted some modest gains.