Discussion
The use of androgen ablation in the treatment of advanced cancer of the prostate has been standard treatment for many years.13 The role for local radiation therapy in patients with distant metastasis is primarily palliative. In this case, it was elected to proceed with external beam radiation to metastatic sites primarily to increase local control of severely involved sites associated with major symptoms and impending serious life- and functionally threatening complications. Specifically, there was evidence of significant anatomic bladder-outlet obstruction and potentially impending neurological compromise due to local extension of disease to the radicular space. Furthermore, the patient demonstrated significant symptoms associated with these involved metastatic sites.13,14 Androgen ablative therapy with abarelix was shown to be highly effective in reducing the PSA to < 0.1 ng/mL in a short period of time. The use of a GnRH antagonist (abarelix) in this setting was critical in view of the severity of symptoms and need for rapid therapeutic effects. In addition, the flare phenomenon (reported in 10% to 30% of patients treated with luteinizing hormone-releasing hormone agonists) is avoided with abarelix, which is a major factor in the selection of GnRH antagonists as the initial treatment approach.13,15