There is great consensus on recommending hormonal therapy as palliative treatment for patients with disseminated disease, or symptomatic patients with localized or locally advanced disease if they meet the following criteria: older than 80 years old; less than 10 years of life expectancy; or contraindication to receive surgical treatment or radiotherapy (that is to say, when curative treatment is not an option).
As regards its use as adjuvant therapy, most guidelines recommend it for patients with locally advanced disease who will undergo radiotherapy (with curative intent) as an option to surgery. The most recently published guidelines extend the recommendation to earlier stages (localized disease), although the evidence found is still controversial. As regards treatment itself, both bilateral orchiectomy and LHRH analogs are generally known for having the same therapeutic efficacy. In general, it is considered that monotherapy with antiandrogens should be used only as second line therapy. Combination therapy (LHRH agonist plus antiandrogens) should not be routinely indicated.