Most of us are familiar with the statistics for prostate cancer. These are expected in the United States in 2001. Most notably, almost 200,000 new cases and, strikingly, in this country, a 1 in 6 lifetime probability.

Back to Dr Huggins. Again, the seminal discovery [was] that hormonal therapy for prostate cancer was effective [by] combining [it] with a biomarker, acid phosphatase. Obviously, now we have prostate-specific antigen (PSA), but both of those were important discoveries in the field.

I think everyone recognizes what hormonal therapy does. An analogy I like to use with my patients is the "fertilizer" analogy, which makes many men understand what hormonal therapy does for prostate cancer, and I think the conventional wisdom that we've had since the [19]40s, since Huggins' discovery, was that hormonal therapy is noncurative but may provide prolonged remission.

But more and more, we're seeing headlines like this: "Hormonal Therapy Extends Life With Prostate Cancer," and that's certainly one of the key discussion points. Does hormonal therapy increase life span? Most of us in our training learned that hormonal therapy is simply palliative. Is this the new paradigm? Does hormonal therapy extend life?

One of the key questions that we're going to address [is], will molecular biologic advances move us beyond hormonal therapy for prostate cancer? Ten years from now, when we're doing this symposium, will we be talking about hormonal therapy? Or will we be talking about gene therapy?

This is the double-stranded DNA helix with a patient in the middle. What's your cancer profile? We're going to hear about molecular profiling. Can we get to the point where we could profile these prostate cancers and design medical treatments based on the molecular biology?

Another key question: when is the best time or stage to use hormonal therapy in the PSA era? All of us face this every day in our practices. Obviously, most of us would agree that patients with stage D2 prostate cancer should be treated with hormonal therapy. I don't think there's any argument if the patients are symptomatic. There are very few people who would withhold hormonal therapy even for a patient with asymptomatic D2. Where does hormonal therapy fit in the guy with PSA recurrence? What's the role of neoadjuvant and adjuvant therapy?

Speaking of PSA recurrence, I think the critical questions of our time [are] where, when, and how should hormonal therapy be used when we have a fellow who has a rising PSA after surgery, radiation, brachytherapy, [or] cryotherapy. This is probably the most common group of patients that we as clinicians are faced with to make the hormonal-therapy decision.

Key question: in node-positive prostate cancer, is delayed hormonal therapy still an option?

I just want to simply show one slide from this New England Journal of Medicine paper. This is the table, which looks at death from prostate cancer. Sixteen deaths from prostate cancer in the observation group had a mean follow-up of 7 years, vs only 3 deaths from prostate cancer in the treatment group.

What is the role of nontraditional hormonal therapy in 2001? And by nontraditional, we mean intermittent hormonal therapy or oral-only hormonal therapy.

You see this headline, "Intermittent Androgen Ablation Promising in Prostate Cancer. "Should we be using intermittent traditional therapy with hormone-releasing hormone (LHRH) agents for our patients? Or should we now be switching to oral-only therapy as a step-up approach and then switch to traditional hormonal therapy when the patient fails? These are some of the questions that we face.

"Casodex (Bicalutamide) Approved for Advanced Prostate Cancer." Obviously, all of us are familiar with the use of bicalutamide as part of combined hormonal therapy; but I think the big news at this American Urology Association [meeting], and over the last year or 2, is the role of bicalutamide or flutamide or even nilutamide as monotherapy as oral-only hormonal therapy to treat PSA recurrence and other earlier stages of disease.