Current controversies in the treatment of high-risk prostate cancer

Purpose of review Despite the well documented stage migration in prostate cancer, a substantial number of men still present to urologists with locally advanced or metastatic disease. Recent findings The beneficial role of prostatectomy has been affirmed in several studies examining its therapeutic impact in locally advanced, nonmetastatic prostate cancer. Adjuvant therapy with radiation or hormones appears to increase prostate-specific antigen relapse-free survival. Whether prostate-specific antigen relapse-free survival is an appropriate surrogate for overall survival remains unverified. The timing and duration of hormonal therapy continues to be debated. Hormone therapy administered 'too late' in the course of metastatic disease portends a shortened survival but possible side effects of androgen ablation must be considered. Several docetaxel-based combination chemotherapies for hormone refractory prostate cancer are being studied, but their efficacy in the neoadjuvant setting thus far has been limited. Progress in the palliation of bony metastases has resulted in a decrease in symptoms and skeletal events. Summary This review identifies seminal data that focus on controversial therapeutic dilemmas in prostate cancer. The literature of the last few years universally emphasizes the importance of a multidisciplinary collaboration in prostate cancer. It is only with this type of cooperation that essential research will continue and succeed.