Future prospects in prostate cancer

BACKGROUND. Prostate cancer has displayed an increase in incidence unparall eled by any other tumor in the last two decades, with a steady, more gradua l increase in mortality rate. Current curative strategies are focused on th e detection and treatment of early-stage (T1-2 N0 M0), clinically significa nt tumors. METHODS. To this aim, refinement of surgical approaches, with appropriate a djuvant therapies, will ensure more complete cancer control, while minimizi ng associated morbidity. New delivery systems for radiotherapy, as well as other energy sources, are evolving, while a number of promising pharmacolog ical agents, including angiogenesis inhibitors and drugs which alter signal transduction pathways, are currently under investigation. Early detection is also being facilitated by a more widespread implementation of screening programs. Advances in tumor markers, and imaging and biopsy techniques, wil l allow more accurate preoperative staging. These, coupled with improvement s in prognostic markers, aid the physician and patient alike in deciding on the suitability of treatment options with better estimation of outcome. Pe rhaps the most exciting developments in prostate cancer will come from know ledge of the molecular mechanisms underlying carcinogenesis. The potential for the development of diagnostic and therapeutic tools is immense. The eff icacy of treatment can be studied at a molecular level, and strategies for preventing or slowing the development of malignancy can be formulated. RESULTS AND CONCLUSIONS. Application of this knowledge in the form of gene and cellular therapy and in the development of novel systemic agents is beg inning to enter the realm of clinical practice, and it may be in this field that means for cure and prevention of prostate cancer will eventually be f ound. (C) 1999 Wiley-Liss, Inc.