Management of Locally Advanced Prostate Cancer: Past, Present, Future

PurposeHistorically advanced prostate cancer had been treated with androgen ablation. With the evolution of radiation therapy it was shown that some patients with advanced but nonmetastatic disease could be cured or at least have progression delayed. Subsequently a series of studies demonstrated that the combination of radiation and androgen ablation resulted in improved results over those of radiation therapy alone, although the failure rate was still high. This review explores the continued evolution in the treatment of high risk disease.Materials and MethodsThe published literature on treatment for high risk prostate cancer was reviewed.ResultsAdding androgen ablation to radiation decreased the failure rate from 79% to 67% in older studies and 55% to 25% in more recent studies. Most contemporary studies of higher radiation doses showed further improvement with a failure rate of 20% to 40%. The results of adding an implant boost appears to have decreased the failure rate further to 30% or less in most studies. There is now great interest in exploring chemotherapy or biological agents as adjuvant therapy to try to improve the results further. The role of surgery in these patients is also awaiting further clarification.ConclusionsRadiation therapy has been the primary mode of curative therapy for high risk prostate cancer for 3 decades. Much progress has been made. Evolving data suggest that radiation will continue to have the primary role in treatment in these patients in the future.