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Current Issues in the Management of Prostate Cancer: Charles Huggins Symposium

  • Authors: Chairperson: Judd W. Moul, MD ; Faculty: Gerhard Coetzee, PhD; Peter Iversen, MD; Edward Messing, MD; Fritz Schrvder, MD, PhD
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Target Audience and Goal Statement

This activity is intended for urologists.

This symposium is dedicated to the research of Charles Brenton Huggins, the only urologist to be awarded the Nobel Prize in Physiology or Medicine (1966), for revealing the role of hormones in the growth and treatment of cancer. Early diagnosis and treatment of prostate cancer has changed the face of this disease, particularly in the later stages. The use of hormonal therapy and the treatment of prostate cancer are evolving rapidly. This symposium will provide a forum for the communication of recent advances in the diagnosis and treatment of prostate cancer with hormonal therapy.

On completion of this CME offering, participants should be able to:

  1. Describe the current management strategies for prostate cancer with hormonal therapy

  2. Discuss the concept of early vs delayed hormonal therapy in different stages of prostate cancer

  3. Review the ongoing clinical trials of hormonal therapy in prostate cancer and understand their clinical application


  • Gerhard Coetzee, PhD

    Departments of Urology, Microbiology and Immunology, and Preventive Medicine, USC-Norris Cancer Center, Keck School of Medicine, Los Angeles, California

  • Peter Iversen, MD

    Associate Professor, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark


    Disclosure: Consultant, Speakers Bureau, AstraZeneca

  • Edward Messing, MD

    Professor and Chairman, Department of Urology, University of Rochester School of Medicine & Dentistry


    Disclosure: Speakers Bureau, AstraZeneca

  • Judd W. Moul, MD

    Director, Center for Prostate Disease Research, Walter Reed Army Medical Center, Washington, DC; Professor of Surgery; Uniformed Services University of the Health Sciences, Bethesda, Maryland


    Disclosure: Speakers Bureau, AstraZeneca

  • Fritz H. Schröder, MD, PhD

    Professor and Chairman of Urology, Erasmus University and Academic Hospital, Rotterdam, The Netherlands.

Accreditation Statements

    For Physicians

  • This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the University of Rochester School of Medicine & Dentistry and IntraMed Educational Group. The University of Rochester School of Medicine and Dentistry is accredited by the ACCME to provide continuing medical education for physicians.

    The University of Rochester School of Medicine & Dentistry designates this educational activity for a maximum of 2 hours in Category 1 credit towards the AMA Physician's Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity.

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For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

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Current Issues in the Management of Prostate Cancer: Charles Huggins Symposium: Hormonal Therapy Overview


Hormonal Therapy Overview, Presented by Judd W. Moul, MD

Prostate Cancer: Background

  • 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.

  • Prostate Cancer - 2001

    Slide 2.

    Prostate Cancer - 2001

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  • Charles Huggins and Hormonal Treatment of Prostate Cancer

    Slide 3.

    Charles Huggins and Hormonal Treatment of Prostate Cancer

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Beyond the Seminal Discovery: Examining the Issues in Hormonal Therapy

  • 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.

  • Hormonal Therapy of Prostate Cancer

    Slide 4.

    Hormonal Therapy of Prostate Cancer

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  • 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?

  • Slide 5.

    (Enlarge Slide)
  • 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?

  • Hormonal Therapy Overview - Key Questions

    Slide 6.

    Hormonal Therapy Overview - Key Questions

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  • 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?

  • Slide 7.

    (Enlarge Slide)
  • 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?

  • Hormonal Therapy Overview - Key Questions

    Slide 8.

    Hormonal Therapy Overview - Key Questions

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  • 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.

  • Focus - Rising PSA

    Slide 9.

    Focus - Rising PSA

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

  • Hormonal Therapy Overview - Key Questions

    Slide 10.

    Hormonal Therapy Overview - Key Questions

    (Enlarge Slide)
  • 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.

  • Hormonal Therapy vs Observation After Surgery for Node-Positive Prostate Cancer

    Slide 12.

    Hormonal Therapy vs Observation After Surgery for Node-Positive Prostate Cancer

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

  • Hormonal Therapy Overview - Key Questions

    Slide 13.

    Hormonal Therapy Overview - Key Questions

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  • 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.

  • Slide 14.

    (Enlarge Slide)
  • "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.

  • Slide 15.

    (Enlarge Slide)