Through the work of Huggins et al.  in 1941, it was shown that metastatic prostate cancer responds positively to an orchiectomy (surgical castration). We now know that there isn’t any other therapy which produces a more reliable regression of both distant and local disease than androgen withdrawal (ADT).
Men with metastatic prostate cancer (mCRPC) who do not respond to hormone therapy (ADT) or who experience early progression (≤1year) have a poor prognosis. There is no consensus regarding the proper next therapy for these men.
Primary, or first line Hormone Therapy (ADT) can involve some different drugs. However, the constant standard includes either a GnRH agonist, such as leuprolide or an antagonist like Firmagon and an antiandrogen like Casodex.
One of the questions that often come up is how long a man should use an antiandrogen drug like Casodex along with a GnRH agonist like Lupron or Zoladex? There is no question that an antiandrogen needs to be used before the first dosage of the agonist (Lupron), but should the antiandrogen be stopped or should it be continued along with the agonist (combining an antiandrogen along with the GnRH agonist is often referred to as a combined androgen blockade)?
First line Hormone Therapy (ADT) involves the use of different drugs. These drugs include three different classes of medications with three different modes of action. They include the GnRH agonists, such as leuprolide, antagonists like Firmagon and the antiandrogens like Casodex.
There is often a choice is between using the LHRH agonist drug (Lupron, Trelstar) or using the gonadotrophin-releasing hormone (GnRH) antagonist like Firmagon.
This brings us to the question, which of these two drugs is superior?
A study found that African American men had a higher rate of death from non-prostate cancer problems than non-African American men after receiving short-term hormone therapy (ADT) prior to having brachytherapy (seeds). There are significant implications beyond this research for African Americans using ADT for any purpose, including he treatment of advanced (progressive) prostate cancer.