As you might expect, treating the cancer with drugs is controversial. In the US, trials have been carried out with 7,000 high-risk patients to see if being routinely treated with Proscar (finasteride), a drug which shrinks the prostate, could do for men's prostates what tamoxifen, an anti-estrogen drug, reputedly does to save women from breast cancer. Urologists have not been convinced about the drug's effectiveness. It takes between three and six months for symptoms to improve, and the drug only appears to work in a minority of patients (see Drug of the Month, p 7). The biggest problem with anti-testosterone (or luteinizing hormone-releasing hormone) drugs like goserelin, besides affecting your sex drive and causing some feminizing, is that there is a risk of any cancer that has spread getting worse and increased pain from cancer in the bones.

Cyprostat (cyproterone acetate), a steroid, which blocks the production and effects of androgens, is often used to counter the effects of LH drugs. But this category of drugs has its own set of potential side effects, including osteoporosis. Nevertheless, these side effects may be worth putting up with, as against surgery which hasn't been proven to do any good.

Non steroids which can be used include: Flutamide (hormone), Nilutamide and Casodex. Currently, drug companies are trying to develop a new breed of alpha blocker which has few side effects and works directly on the prostate.

!AClive Couldwell

Clive Couldwell writes for the London Times, The Daily Telegraph and The Financial Times newspapers.