Hormonal therapy of prostatic carcinoma. Defining the challenge.

Prostate cancer is the most common neoplasm in the American male. More than 50% of patients present with locally advanced or metastatic disease and are not curable with local therapies such as radical prostatectomy or radiation therapy. This cancer is hormonally dependent, and methods that interrupt the hypothalamus-pituitary-testicular axis have been used to treat and control the disease effectively. The role of neutralizing the adrenal androgens is controversial. Combined androgen blockade refers to treatment modalities that lower circulating serum testosterone such as bilateral orchiectomy or an LH-RH agonist and combining it with an antiandrogen. The issue at hand is to review current clinical trials addressing the concept of combined androgen blockade and to determine the feasibility of a meta-analysis.