Historically, patients with locally advanced prostate cancer have had poor rates of disease control regardless of which treatment modality they received. Although the optimal management approach for these patients remains to be determined, the addition of androgen suppression (AS) to radiotherapy has been shown to improve both biochemical control and overall survival rates. Data from randomized and retrospective studies support the importance of local control and radiation dose in treating patients with locally advanced disease. Dose-escalated radiotherapy using such modern techniques as intensity-modulated radiation therapy and permanent interstitial or high-dose-rate brachytherapy is associated with improved disease control rates compared with results achieved historically with older radiotherapy methods. Recent data suggest that radiation dose remains important when radiotherapy is used concurrently with AS.
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