Some two months ago I posted some excerpts on this issue (When Should
You Begin Hormonal Therapy?) from Dr. Patrick Walsh's "Guide to
Surviving Prostate Cancer". That originated an interesting thread…

As I wrote at that time, this is a relevant issue for many of us.

Meanwhile, I bought Dr. Peter Scardino's "Prostate Book" (paperback
edition 2006) and thought it would be useful to post an excerpt from
this book. Here it goes, below.

Just
 

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Hormone Therapy (page 414)

"Experts disagree about the value of early versus late hormone
therapy. We even lack consensus about what constitutes "early" or
"late," though basically, early treatment means starting hormones soon
after the PSA begins to rise, and late means beginning the therapy
when symptoms or clinical signs of metastases seem imminent. There is
general agreement that it's probably not necessary to begin hormone
treatment and deal with the unpleasant side effects at the very first
sign of a rising PSA. Most experts also concur that waiting until a
man has signs or symptoms of metastases is unwise. Unfortunately, we
have no crystal ball that can predict with certainty exactly when
metastases will appear. In deciding when to begin hormone treatment,
we look at the seriousness of the original tumor. If the cancer was
high-grade (Gleason 8 to 10, stage T3a or higher) before radiation
treatment, or if the pathologist found cancer in the seminal vesicles
or pelvic lymph nodes after surgery, metastases are likely to develop
sooner than they would in someone whose original tumor was Gleason 7
or below and stage TI or T2. A short PSA doubling time of less than
ten months also predicts more rapid distant spread. The bone scan
monogram can also be useful in this setting (see page 400). Be sure to
communicate carefully with your physician to ensure that you
understand and agree with his philosophy about hormone treatment and
that your personal needs and preferences are taken into account.
If you participate in a clinical trial (see Experimental Therapies on
page 419 and the section on Investigational Treatments on page 408),
the rules of the study may govern when your treatment will begin. If
you don't enter a trial, I certainly recommend beginning hormone
therapy before a bone scan or other tests identify a definite site of
metastases. If your PSA is followed regularly, your doctor can monitor
the PSA level and doubling time and start you on hormone treatment
when the pace of cancer growth starts to accelerate. In my view,
you're probably best off delaying hormone therapy until it appears
necessary. I've seen inadequate evidence to date that starting this
treatment earlier prolongs life, and withdrawing hormones does cause
troubling side effects. When we studied men given hormone therapy for
rising PSA after radical prostatectomy at Memorial Sloan-Kettering
Cancer Center, we found that 50 percent responded for ten years,
meaning the PSA dropped and stayed low. But ten years is a long time
to deal with the side effects of androgen deprivation, which can
include loss of libido and erectile function, hot flashes, decreased
muscle mass, thinning of bones and increased risk of fracture, breast
enlargement and tenderness, anemia, and possibly diminished mental
acuity. The benefits of early androgen deprivation would have to be
substantial to balance these negative effects. Nevertheless, anxiety
drives many men to demand hormone therapy early, and they are
understandably reassured by the dramatic fall in PSA.

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NOTE: I recommend a cautious approach to hormone therapy for
metastatic prostate cancer. While it can be comforting to have your
PSA fall dramatically or even become undetectable, the relevant issue
is what's really happening to your cancer and how you can enjoy the
best quality of life for as long as possible.
---

Some experts advocate intermittent hormone therapy. Patients are given
hormone-suppressing drugs until the PSA drops to undetectable levels.
When it does, they are taken off the medication. Testosterone
production resumes, and side effects associated with its absence
(including sexual dysfunction) can resolve. When the PSA rises,
hormone treatment begins again.
Intermittent therapy offers a false promise that men can enjoy more
time free of the side effects of hormone therapy. In fact, the major
benefit is during the first cycle, when patients can be on the drugs
for 60 percent of the time and off for 40 percent. With subsequent
cycles, the time to a rising PSA shortens, and treatment must resume
sooner. Since it takes a while after the drugs are stopped to regain
functional testosterone levels, the actual amount of time that a man
can be sexually active and relieved of other side effects such as
weight gain, mood swings, anemia, lethargy, and hot flashes mar boil
down to only 10 to 15 percent of his remaining lifetime. PSA is such a
powerful, effective early warning system that overall quality of life
may be better if we simply postpone hormone treatment until the PSA
reaches 20 or so, or there are other signs of impending trouble".