There has been along standing controversy pertaining to the timing of ADT initiation (i.e. early verses late).
However, in 2002 the Cochrane meta-analysis (Nair B, Wilt T, MacDonald R et al., “Early versus Deferred Androgen Suppression in the Treatment of Advanced Prostate Cancer”, Cochrane Database Syst Rev (2002); (1): CD003506) clarified this issue.
Initiating early ADT immediately at the time of diagnosis of metastic disease, rather than delaying the commencement of treatment until symptom development, was associated with significantly higher progression-free survival. In addition, early initiation also demonstrated lower morbidity rates and a significant increase in overall survival at 10 years.
Thoughts of who are recently diagnosed with advanced disease must insist that we start Hormone Suppression immediately upon diagnosis.
Joel T Nowak MA, MSW