The 2008 Genitourinary Cancers Symposium in San Francisco featured a session on anticipating failure in the patient with advanced prostate cancer. Anthony Zietman, MD, the Jenot and William Shipley Professor of Radiation Oncology at Harvard Medical School in Boston, made his case for the use of adjuvant external beam radiation therapy. Adam Kibel, MD, associate professor of surgery in the division of urologic surgery at Washington University School of Medicine in St. Louis, argues in favor of systemic treatment.