• Androgen deprivation therapy ((ADT) gonadal suppression) is the standard first line therapy for patients with metastatic prostate cancer. This can be accomplished medically with the use of an LHRH-agonist or antagonist or by bilateral orchiectomy • The addition of an anti-androgen (short course or continuous) must be individualized taking into account symptoms, sides effects, and costs of therapy • Pending results of completed randomized trials, intermittent androgen deprivation therapy can be used but is considered experimental • Physicians managing patients should attend to the long-term toxicity from ADT, particularly effect on BMD and the metabolic syndromes • Considering the inevitability of progression in virtually all patients undergoing ADT, new treatment strategies targeting mechanisms of progression are an active area of investigation.