Three out of four men who develop advanced prostatic cancer may soon be able to look forward to years of worthwhile, active life.

Until a year or two ago few other than Dr Johann de Bono, and his research team at the Royal Marsden Hospital, believed that this would ever be possible. Their discovery of abiraterone, a drug to treat advanced prostatic cancer that is no longer responding to hormone therapy, is the latest and arguably the most remarkable advance in the treatment of prostatic cancer during the past 15 years.

It gives hope that other new drugs such as ZD4054 that act in different ways on late-stage prostatic cancer may also be successful. There is also a rumour that a diagnostic test that is more finely honed than the prostate specific antigen (PSA) blood test is being developed and is proving effective.

Eleven years ago at a charity lunch in London, Roger Kirby, a surgeon at St George's Hospital, spoke about the woeful state of the treatment of prostate diseases in this country. Although prostate cancer affects more than 35,000 men annually and kills 10,000, at that time less money was spent each year by the NHS on research into prostatic disease than many of the luncheon guests would spend on their next car.

Those present discussed the failure of the medical profession and politicians to tackle the rising death rate from cancer of the prostate. They also decried the failure of the NHS to make reasonable arrangements for its early diagnosis and encourage doctors to provide radical prostatectomy or radiotherapy.

Radical prostatectomy, the treatment that offered the chance of a cure, was carried out only by a minority of British urologists. The dose that radiotherapists were able to administer to patients was enough to inhibit the growth of the cancer rather than to destroy it.

But the outlook for patients with prostatic cancer has been revolutionised over the past 15 years. Radical prostatectomy is now generally accepted as the gold-standard treatment, and is available throughout the country for those whose disease is diagnosed early enough and are clinically suitable.

Robotic surgery has made the radical operation safer and less destructive and the number of robots and the surgeons to operate them is beginning to become comparable to the numbers employed in other Western countries. Radiotherapy departments are now equipped with computerised controlled machinery that can deliver a big enough dose sufficiently accurately to eradicate the cancer without destroying the surrounding tissue.

Brachytherapy (where a radioactive source is implanted into the affected area) is becoming an established and justifiably acceptable alternative to external-beam radiotherapy. For some of those who have had a recurrence of the cancer after previously inadequate radiotherapy, high-intensity focused ultrasound (HIFU) is now available as a salvage operation. HIFU treatment is also an alternative therapy for men with a tumour that is still confined to the prostate who are not suitable for or willing to have a prostatectomy.

These changes benefit patients who receive a diagnosis at a relatively early stage and have tumours that respond to standard treatment. But there are other patients who have highly malignant cancers that have spread early or have been diagnosed or treated too late for a good result. They would have needed radiotherapy and also immediate hormone therapy to deprive the cancer of the testosterone essential for its growth and spread. Unfortunately, after a variable time the tumours become hormone refractory and the cancer cells begin to manufacture testosterone, enabling the tumour to flourish once more.

Once a prostatic cancer and its secondary growths have become hormone-refractory most patients can currently expect only 18 months or so of good-quality life. Now 75 per cent of these apparently end-stage patients have been thrown a lifeline of hope from the Royal Marsden. The researchers there confirmed in the Journal of Clinical Oncology that abiraterone appears to counter hormone-refractory cancers by neutralising the testosterone the cancer cells are producing.

The current trial is relatively small but large enough, with results good enough, to justify patients' optimism. Deprivation of testosterone is not without side-effects and so would not be the initial treatment of choice, but it seems that it will become a remarkably efficient long stop.

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