Now is the time to answer critical questions in the management of prostate cancer through enrollment in high-priority national phase 3 clinical trials. Studies of systemic therapy before and after local therapy are vitally important to determine whether early systemic interventions might delay cancer progression. Chemotherapy must be studied in earlier disease progression. Novel targeted therapies, such as vaccine therapy, angiogenesis inhibitors, and newer microtubule targeting agents, should be studied in all stages of progression. Despite these needs and the availability of systemic therapies, accrual to trials has been lagging. This article reviews the national cooperative group clinical trials, whether currently open or planned, and suggests practical strategies to improve accrual.
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