For castration-naive metastatic prostate cancer patients who you plan to treat with LHRH agonist monotherapy, how long do you treat with an anti-androgen therapy prior to and after initiating the LHRH-agonist?

A recent systematic review suggested that disease progression owing to a testosterone "flare" may not be a real phenomenon: http://www.ncbi.nlm.nih.gov/pubmed/25159013.

Are there particular studies that influence your practice with regard to use and timing of anti-androgen therapy when starting an LHRH-agonist? Should this be guided by biochemical data (eg., testosterone levels) for individual patients?

Answer from: Medical Oncologist at Academic Institution

I only use bicalutamide prior to starting LHRH agonist in patients with high risk of spinal cord compression or urinary obstruction. I will start bicalutamide for 7 days then start LHRH agonist therapy. In all other patients, I start LHRH agonist without combination with anti-androgen...

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For castration-naive metastatic prostate cancer patients who you plan to treat with LHRH agonist monotherapy, how long do you treat with an anti-androgen therapy prior to and after initiating the LHRH-agonist?

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