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