High-Risk Prostate Cancer: Local Therapy Matters

In recent years, a large focus of the management of prostate cancer has been to de-intensify treatment. Strategies to reduce treatment include decreasing the number of radiation treatment (RT) sessions, omitting surgery or RT altogether for men not expected to die of prostate cancer, and eliminating PSA screening completely. These could be effective strategies to decrease overtreatment, reduce the adverse effects of screening and treatment, and ultimately help to decrease the cost of medical care. There remains a population of men, however, who are diagnosed with more aggressive, locally advanced prostate cancer for which the standard treatment options are lacking and intensification of treatment is needed. This review summarizes treatment options for men with high-risk prostate cancer, including radical prostatectomy, external-beam radiotherapy (EBRT), and androgen-deprivation therapy (ADT). The focus here, however, will be on examining strategies to improve outcomes though intensification of local therapy using a combination of brachytherapy, EBRT, and ADT.