Locally advanced prostate cancer is a treatment dilemma. As with prostate cancer in general, there is no clear evidence that aggressive intervention (ie, surgery or radiation) is superior to noninvasive interventions (eg, delayed treatment or androgen ablation). Because patients with locally advanced prostate cancer have a high risk of local and systemic recurrence, there is some argument to proceed with androgen ablation as the sole modality of treatment. The data using this approach are limited, but an understanding of the degree and duration of response is helpful in selecting patients for primary androgen ablation.
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