Optimising Hormone Therapy in Localised and Early Disease

For patients with biochemical failure, androgen deprivation therapy is appropriate for those whose clinical and pathologic parameters indicate that local recurrence is unlikely. For such patients who are at high risk (Gleason ≥8, or PSA DT <1 year), androgen deprivation should be implemented when the PSA is between 5 and 10 ng/mL. For lower risk patients, or those who have secondary failure after initial attempt at salvage radiation, there is no evidence that early androgen deprivation enhances survival or time to androgen independent progression. These patients should be monitored and treated upon clinical progression or rapid biochemical progression.