How is androgen-dependent metastatic prostate cancer best treated?

The median survival for men with systemic metastases from prostate cancer ranges between 2 and 3 years, depending primarily on the extent of disease at diagnosis. Androgen deprivation has been the mainstay of therapy since Huggins demonstrated its utility in 1941. It can be accomplished surgically or medically with essentially equivalent results. Newer modalities, such as combined androgen blockade, intermittent androgen blockade, and chemohormonal therapy, have not been shown to improve survival consistently. Subsets of patients, however, may derive additional benefit from these innovative therapies.