Where to now with hormonal therapy in prostate cancer?

Hormonal ablation has been an accepted treatment for prostate cancer for more than a century, first through surgical orchiectomy, then through estrogen therapy. Nonsteroidal antiandrogens and gonadotropin releasing hormone (GnRH) analogues had their debut in the 1980s, followed by the 5α-reductase inhibitors and ketoconazole, and in the 1990s, high-dose antiandrogens. But orchiectomy is still the gold standard of hormonal management, a modality that is making a comeback as the comparator for some of the newer treatments. And while androgen ablation is important for improving local control before surgery or radiotherapy, lengthening survival times in advanced disease and providing palliation in patients with metastases, few patients achieve complete responses and there is a continued risk of death over time. 'There is no plateau to the [mortality] curve', is how 1 speaker phrased the situation at the 95th Annual Meeting of the American Urological Association (AUA) [Atlanta, US; April-May 2000].