1. Triptorelin (Decapeptyl®) is the preferred first choice GnRH analogue where appropriate for newly diagnosed patients.

2. Goserelin (Zoladex®) is included as neoadjuvant or adjuvant treatment in prostate cancer and as a second line alternative being the only licensed product for use in the treatment of breast cancer and IVF.

3. Given the emotive clinical indications this therapy is used to treat there is no compulsion at present to change existing patients' therapy or agreed treatment regimens. Local specialists agree that all GnRH analogues are equally effective and will continue to recommend treatment with a 'GnRH analogue' rather than a specific brand of product to be used unless clinically indicated. Specialists agree that general practitioners can change the product prescribed within this class of therapy to complete courses of therapy for existing patients as clinically appropriate and after informed discussions with the patient.

4. Flutamide is given to counter tumour flare with initial gonadorelin therapy. Used for up to 3 weeks in patients with symptomatic and advanced prostatic carcinoma only.

5. HEPATOTOXICITY. Direct hepatic toxicity including jaundice, hepatitis and hepatic failure has been reported (usually after several months) in patients treated with cyproterone acetate 200 - 300 mg daily. Liver function tests should be performed before treatment and whenever symptoms suggestive of hepatotoxicity occur - if confirmed cyproterone should normally be withdrawn. Cyproterone is no longer recommended for long term use.

6. Bicalutamide is the only anti-androgen licensed as a single agent for monotherapy in a patient with locally advanced disease. The dosage of bicalutamide is 150 mg OD as a single agent, or 50 mg OD when given in conjunction with gonadorelin analogue injection therapy. Care should be taken to ensure correct choice of dose.