Management of Locally Advanced (Nonmetastatic) Prostate Cancer

Abstract

Locally advanced prostate cancer is decreasing because of stage migration with prostate-specific antigen (PSA) testing. The natural history of these tumors reflects a significant risk of morbidity and mortality from local and metastatic disease progression. The balance of risks and benefits of treatments need to be discussed carefully with men and their families, ideally using a shared decision-making approach. The aim of treatment is to eradicate the primary malignancy with the lowest risk of local or systemic relapse, and minimal morbidity from side effects or complications. While radiation therapy combined with hormonal therapy has traditionally been preferred, there is increasing evidenc..