In the late 1970s, investigators learned that androgen-deprivation therapy (ADT) decreased serum testosterone levels and, more importantly, reduced bone pain among men with prostate cancer. Whereas ADT demonstrated benefit in patients with metastatic disease and as an adjunct to radiation therapy in patients with locally advanced disease, its use at the organ-confined stage has never been supported by evidence or expert guidelines. Most importantly, randomized data have shown that immediate ADT for nonmetastatic prostate cancer not only lacks a survival benefit but may cause harm, such as an excess risk of bone fractures. Nevertheless, the use of ADT for localized prostate cancer increased greatly between the 1990s and early 2000s with compelling evidence that favorable reimbursement contributed to this trend.
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