The future of endocrine treatment in early prostate cancer: concluding remarks

Prostate cancer screening, involving markers such as prostate-specific antigen, has enabled the detection and diagnosis of prostate cancer much earlier in life and at an earlier stage of disease. This earlier diagnosis, with the potential for earlier and longer endocrine exposure, has implications on treatment options for early prostate cancer. Treatment options that need to be considered are immediate versus deferred treatment, adjuvant therapy, intermittent treatment and step-up treatment. Preliminary reports indicate advantages for immediate compared with deferred therapy in terms of time to progression and overall survival. There are studies in progress for the other treatment options that should resolve some of the uncertainties about the management of early prostate cancer. The need to balance long-term side effects against potential survival advantage is of particular importance in patients who may be receiving endocrine therapy for longer periods. As antiandrogens are associated with quality of life benefits when compared with castration, the non-steroidal antiandrogen bicalutamide, which is currently being investigated as monotherapy(1) and as adjuvant therapy, may prove to be a useful treatment option for patients with early prostate cancer.