Multiple intracrine hormonal targets in the prostate: opportunities and challenges.

The use of currently available approaches to the early diagnosis and treatment of prostate cancer can virtually eliminate death from this disease. With current techniques, screening can detect prostate cancer at a clinically localized stage in 99% of cases [4]. Radical prostatectomy, radiotherapy or brachytherapy can be instituted immediately, with curative intent, after such early diagnosis. There are data indicating that excellent results can be expected with CAB, particularly in older patients [5]. Most importantly, CAB must be used immediately in patients for whom radical prostatectomy, radiotherapy or brachytherapy fails. It is often erroneously thought that resistance will develop to androgen blockade in localized disease, and that this treatment should therefore be delayed until a later stage of the disease; this is incorrect. The use of CAB to treat localized prostate cancer does not lead to resistance to treatment. However, when treatment is deferred, the possibility of cure is very often lost because of metastasis of the cancer to the bone. In this situation, resistance to treatment cannot then be avoided. It should be appreciated that when prostate cancer is first detected, even by screening, the tumour diameter is ≈ ≥ 1 cm. Immediate treatment is the only treatment that offers a strong hope of cure. When radical prostatectomy, radiotherapy or brachytherapy fails, CAB must be started immediately. CAB can also be used alone as primary therapy with excellent results, as shown in important recent studies [5–9].