New strategies for the treatment of hormone-independent prostate cancer

It is quite likely that in every prostate cancer, at the start of clinical disease there are hormone-independent cells present. These cells may be sensitive to changes in the diet, to chemotherapeutic agents, to immunological agents, to the use of vaccines or may be sensitive to radiotherapy. The introduction of these non-hormonal therapies has classically been reserved for the time when the patient has exhausted all other treatment therapies and has a large tumour volume which will almost certainly not respond to such treatments. The purpose of this chapter will be to try to arrive at a more sensible definition of hormone-independent disease than has been used in the past, to outline some of the new treatment strategies and to make suggestions as to where in the natural history of the disease these would be most effectively and easily employed.