Hormonal approaches in prostate cancer: application in the contemporary prostate cancer patient

Early studies beginning in the 1940s confirmed the importance of the androgen receptor and benefits of androgen depletion in metastatic prostate cancer. These studies helped to establish management strategies with an excellent response rate. Despite this, there remains some controversy as to the optimal approach for patients. Fueling this controversy is the fact that routine PSA testing did not come into practice until the early 1990s, while the majority of the large trials evaluating the use of hormonal therapy were conducted in the pre-PSA era and in patients who had metastatic disease identifiable with radiographic imaging. With the onset of routine PSA testing and the subsequent stage migration that has occurred in men presenting with prostate cancer, the question of when to initiate hormonal therapy has become ever more controversial.