For more than 30 years, maximal androgen blockade has been used in urologic oncology clinical trials practiced with varied degrees of success in the treatment of prostate cancer. While the popularity of maximal androgen blockade has waxed and waned, currently maximal androgen blockade appears to be the optimum treatment for the management of advanced prostate cancer. This opinion paper is intended to review the current approach of maximal androgen blockade and, in particular, address its role in clinical practice. This article reflects the views of 14 urologic experts from Canada, the US and Europe.