| Surgical castration by orchidectomySurgical castration | | | | testosterone levels are maintained in the |
| is the simplest and cheapest way to treat metastatic | | | | bloodstream. Anti-androgens alone are probably not |
| prostate cancer. The obvious disadvantage is the | | | | adequate treatment for metastatic disease. Total |
| psychological effect of the loss of the | | | | androgen blockade by a combination of steroidal |
| testicles.LHRH-analoguesLHRH-analogues and | | | | anti-androgens and LHRH-analogues or orchidectomy |
| oestrogen achieve a "medical castration" by stopping | | | | has not been shown to be better than |
| the testicular production of testosterone. | | | | LHRH-analogues or orchidectomy alone. However, |
| LHRH-analogues are injections that have to be given | | | | non-steroidal anti-androgens yields slightly better |
| monthly or three monthly for the rest of the | | | | results than castration alone.Locally advanced disease |
| patient's life. They are effective but very | | | | without metastases.The overall results of treatment |
| expensive.OestrogenOestrogen can be taken orally | | | | of patients with disease beyond the prostate are not |
| on a daily basis. It has a high incidence of thrombotic | | | | good. Some patients with early disease beyond the |
| complications such as stroke and myocardial | | | | prostatic capsule, and no evidence of metastases, |
| infarction.Anti-androgensAnti-androgens oppose the | | | | benefit from radical treatment. The most widely used |
| action of testosterone by blocking the androgen | | | | treatment regimens consist of a combination of |
| receptors. The incidence of erectile dysfunction is less | | | | radiotherapy and hormonal treatment.Treatment |
| than with surgical or medical orchidectomy because | | | | options for locally advanced and metastatic disease. |