Therapeutic options in locally defined or advanced prostate cancer

Objective: Critical discussion of the available therapeutic options in loca lly defined or advanced prostate cancer (PCa) in the absence of standards o r guidelines. Methods: Medline-based survey of the pertinent literature. Th e therapeutic options are presented stage-by-stage. Results: Intracapsular PCa (T-1a-T2bN0M0) is preferably managed by radical prostatectomy; 'insigni ficant' cancers may be treated expectantly. The outcome of irradiation is n ot as predictable as radical surgery. The following points regarding treatm ent of locally advanced PCa are still under debate: neoadjuvant treatment i s probably not as efficient as believed; technical refinements of radical p rostatectomy may be helpful; in some instances, the value of adjuvant treat ment is undecided. The efficacy of irradiation in conjunction with androgen deprivation probably equals the efficacy of surgery. No consensus can be f ound in the presence of positive lymph nodes, although single institutions achieve remarkable results with surgery plus androgen deprivation. Conclusi on: Prognostic factors beside the clinical stages and grades should be inco rporated in the treatment decision, and quality-of-life measurement should gain more importance when the treatment outcome is assessed.