| Surgical castration by orchidectomy | | | | Anti-androgens |
| Surgical castration is the simplest and cheapest way | | | | Anti-androgens oppose the action of testosterone by |
| to treat metastatic prostate cancer. The obvious | | | | blocking the androgen receptors. The incidence of |
| disadvantage is the psychological effect of the loss | | | | erectile dysfunction is less than with surgical or |
| of the testicles. | | | | medical orchidectomy because testosterone levels |
| LHRH-analogues | | | | are maintained in the bloodstream. Anti-androgens |
| LHRH-analogues and oestrogen achieve a "medical | | | | alone are probably not adequate treatment for |
| castration" by stopping the testicular production of | | | | metastatic disease. Total androgen blockade by a |
| testosterone. LHRH-analogues are injections that | | | | combination of steroidal anti-androgens and |
| have to be given monthly or three monthly for the | | | | LHRH-analogues or orchidectomy has not been |
| rest of the patient's life. They are effective but very | | | | shown to be better than LHRH-analogues or |
| expensive. | | | | orchidectomy alone. However, non-steroidal |
| Oestrogen | | | | anti-androgens yields slightly better results than |
| Oestrogen can be taken orally on a daily basis. It has | | | | castration alone. |
| a high incidence of thrombotic complications such as | | | | Locally advanced disease without metastases. |
| stroke and myocardial infarction. | | | | |