Several different hormonal approaches can benefit men with various stages of prostate cancer. These include bilateral orchiectomy, estrogen therapy, LHRH agonists, antiandrogens, ketoconazole, and aminoglutethimide. Benefits of bilateral orchiectomy include ease of the procedure, compliance, its immediacy in lowering testosterone levels, and low cost. Disadvantages include psychologic effects, loss of libido, impotence, hot flashes, and osteoporosis.[39] Estrogens at a dose of 3 milligrams per day of diethylstilbestrol will achieve castrate levels of testosterone. Similar to orchiectomy, estrogens may cause loss of libido and impotence. Gynecomastia may be prevented by low-dose radiation to the breasts. However, estrogen is seldom used today because of the risk of serious side effects including myocardial infarction, cerebrovascular accident, and pulmonary embolism. LHRH agonists such as leuprolide, goserelin, and buserelin will lower testosterone to castrate levels. Similar to orchiectomy and estrogens, LHRH agonists cause impotence, hot flashes, and loss of libido. Tumor flare reactions may occur transiently but can be prevented by antiandrogens or by short-term estrogens at low dose for several weeks. The pure antiandrogen flutamide may cause diarrhea, breast tenderness, and nausea. There have been case reports of fatal and nonfatal liver toxic effects.[40] Bicalutamide may cause nausea, breast tenderness, hot flashes, loss of libido, and impotence.[41] The steroidal antiandrogen megestrol acetate suppresses androgen production incompletely and is generally not used as initial therapy. Long-term use of ketoconazole can result in impotence, pruritus, nail changes, and adrenal insufficiency. Aminoglutethimide commonly causes sedation and skin rashes. Additional studies that evaluate the effects of various hormone therapies on quality of life are required.[42]

The designations in PDQ that treatments are "standard" or "under clinical evaluation" are not to be used as a basis for reimbursement determinations.

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