The early recurrence of prostate cancer originally staged as locally more than T2 and nonmetastatic, cast doubts over the adequacy of the staging of this form of the disease. Monotherapy with curative intent, either by radical prostatectomy or radiotherapy, results in around half of the patients failing within 5 years. While improvements in staging of the disease are essential, the early results of combined modality therapy, particularly the combination of neoadjuvant hormones and surgery, have been disappointing. Neo-adjuvant maximal androgen blockade followed by radiotherapy does appear to offer survival benefit for patients with locally advanced disease, and other studies combining radiotherapy adjuvant hormonal therapy and surgery with routine postoperative with radiotherapy are eagerly awaited. Combination therapy might not give the hoped-for additive effects of the two therapies, but almost certainly will give an increased incidence of complications.

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