First-Line Hormonal Manipulation of Prostate Cancer

We have been aware that prostate cancer is a hormone sensitive tumour and dependent on testosterone for its growth and spread since the pioneering studies of Charles Huggins and Clarence Hodges in 1941. Surgical castration was established as the gold standard for the treatment of advanced prostate cancer, but given its irreversibility and damaging psychological effects on men, the development of effective medical-based castration therapy was inevitable. This chapter considers the different forms of androgen deprivation therapy (ADT). Given the increasing usage of medical castration in more men, at earlier stages of the disease, we then go on to examine the evidence to support their use across the spectrum of different stages of the disease.