healthcare professionals should offer bilateral orchidectomy to all men with metastatic prostate cancer as an alternative to continuous LHRH agonist therapy (1)
LHRH agonist
anti-androgen monotherapy
do not offer combined androgen blockade as a first-line treatment for men with metastatic prostate cancer
metastatic prostate cancer who are willing to accept the adverse impact on overall survival and gynaecomastia in the hope of retaining sexual function, anti-androgen monotherapy with bicalutamide should be offered (1)
begin androgen deprivation therapy and stop bicalutamide treatment in men with metastatic prostate cancer who are taking bicalutamide monotherapy and who do not maintain satisfactory sexual function
maximal androgen blockade:
bilateral orchidectomy plus
anti-androgen
combined androgen blockade is not recommended as a first-line treatment for men with metastatic prostate cancer (1)
chemotherapy:
docetaxel is recommended, within its licensed indications, as a treatment option for men with hormone-refractory metastatic prostate cancer only if their Karnofsky performance-status score is 60% or more (2)
bisphosphonates
bisphosphonates for pain relief may be considered for men with hormone-refractory prostate cancer when other treatments (including analgesics and palliative radiotherapy) have failed
should not be used routinely to prevent osteoporosis in men with prostate cancer receiving androgen withdrawal therapy
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