To help doctors determine when to use hormone therapy for men with advanced prostate cancer that responds to treatment with anti-androgens, ASCO recommends the following:

• For most men, the initial recommended treatment is the removal of testosterone through a bilateral orchiectomy or with an LHRH agonist drug. Each procedure has a specific set of physical and psychological side effects, and it is important to talk with your doctor to understand the risks and benefits of each treatment.
• An alternative to surgical or medical castration is a nonsteroidal anti-androgen drug. Bicalutamide (Casodex), flutamide (Eulexin) and nilutamide (Nilandron) are examples of anti-androgens. This treatment is as effective as a bilateral orchiectomy or an LHRH agonist drug, but it has different side effects (most notably, less effect on a man's sex drive).
• For men with prostate cancer that continues to grow and spread, CAB treatment lowers the risk of death by more than either method listed above. However, there may also be an increase in potentially serious side effects. It is important to talk with your doctor about risks and benefits of this treatment, especially in the context of your own health history.
• The timing of starting ADT should be discussed with your doctor. Research shows that starting treatment right away may not always be better. Most doctors recommend beginning treatment when a man shows symptoms of recurrent or progressive cancer. Men who are not treated right away should meet with their doctors every three to six months to monitor the cancer.
• Intermittent hormone therapy is given for a specific time, stopped temporarily, and restarted again once the PSA hits a certain predetermined level. At this time, the use of intermittent hormone therapy is still considered experimental. Although a man's quality of life will likely be better during the “off therapy” periods (the time when the hormones are temporarily stopped), it is not known whether intermittent hormone therapy controls the cancer as long as continuous hormone therapy.