Androgen deprivation therapy

Androgen suppression should be continued with luteinizing hormone-releasing hormone (LHRH) agonist or antagonist unless previous bilateral orchidectomy had been performed. Patients who progress on LHRH treatment or orchidectomy, should be started on an anti-androgen such as bicalutamide. Following further disease progression, the anti-androgen should be withdrawn.1As per the Prostate Cancer Working Group 22consensus, there is no need to wait for a withdrawal response before initiating further therapy if there has been no response to adding anti-androgen to LHRH treatment or orchidectomy. Retrospective studies have also demonstrated limited PSA response when alternative anti-androgens, e.g. bicalutamide, flutamide, nilutamide, are used following progressive disease.3