1. Introduction E. David Crawford, MD Professor of Surgery and Radiation Oncology University of Colorado Health Sciences Center Denver, Colorado

2. Advanced Prostate Cancer: Classification Refinements Within the A-B-C-D Staging System Adapted with permission from Crawford and Blumenstein. Urology. 1997;50:1027. Stage Defining Feature D0Elevated prostatic acid phosphatase D1Pelvic lymph node involvement D1.5Rising PSA after failed local therapy D2Metastatic disease D2.5Rising PSA after nadir level D3Hormone refractory D3SHormonally sensitive D3IHormonally insensitive

3. Hormonal Therapy Type Combined androgen blockade Combined androgen blockade Monotherapy-LHRH agonist, orchiectomy, estrogens, anti-androgens Monotherapy-LHRH agonist, orchiectomy, estrogens, anti-androgens LHRH antagonist LHRH antagonist Experimental: low-dose anti-androgens, differentiation agents, diet Experimental: low-dose anti-androgens, differentiation agents, dietLength Long-term Long-term Defined period of 1, 2, 3, 4 or more years Defined period of 1, 2, 3, 4 or more years Intermittent Intermittent

4. EGF LHRH FGF Retinoid Vitamin D DHTDHT DHT = dihydrotestosterone; EGF = epidermal growth factor; FGF = fibroblast growth factor.