Surgical castration by orchidectomy

Surgical castration is the simplest and cheapest way to treat metastatic prostate cancer. The obvious disadvantage is the psychological effect of the loss of the testicles.

LHRH-analogues

LHRH-analogues and oestrogen achieve a "medical castration" by stopping the testicular production of testosterone. LHRH-analogues are injections that have to be given monthly or three monthly for the rest of the patient's life. They are effective but very expensive.

Oestrogen

Oestrogen can be taken orally on a daily basis. It has a high incidence of thrombotic complications such as stroke and myocardial infarction.

Anti-androgens

Anti-androgens oppose the action of testosterone by blocking the androgen receptors. The incidence of erectile dysfunction is less than with surgical or medical orchidectomy because testosterone levels are maintained in the bloodstream. Anti-androgens alone are probably not adequate treatment for metastatic disease. Total androgen blockade by a combination of steroidal anti-androgens and LHRH-analogues or orchidectomy has not been shown to be better than LHRH-analogues or orchidectomy alone. However, non-steroidal anti-androgens yields slightly better results than castration alone.

Locally advanced disease without metastases.

The overall results of treatment of patients with disease beyond the prostate are not good. Some patients with early disease beyond the prostatic capsule, and no evidence of metastases, benefit from radical treatment. The most widely used treatment regimens consist of a combination of radiotherapy and hormonal treatment.

Treatment options for locally advanced and metastatic disease.