Future directions in prostate cancer treatment: an oncologist's perspective.

Prostate cancer has become one of the most important national health problems, as its incidence increases yearly. Conventionally, single-modality local therapy has been the standard of care for clinically localized stage disease and systemic therapy, in the form of primary or combined androgen deprivation, is reserved for advanced, usually metastatic, prostate cancer. Despite improvements in local therapy, a significant number of patients with clinically localized prostate cancer will suffer a systemic relapse after potentially curative local therapy and, despite 50 years of experience in hormone therapy, significant survival prolongation for patients with metastatic prostate cancer remains a challenge. This paper explores potential future systemic therapy strategies in the treatment of prostate cancer. Specifically, the role of adjuvant systemic therapy as part of a multimodality treatment approach for localized prostate cancer and alternative applications of hormone and chemohormone therapies for patients with metastatic disease are discussed.