Risk-Based Management of Prostate Cancer

Randomized trials (EORTC 228631; SPCG-72; and TROG 96013) (Table 1) have established external-beam radiation therapy plus hormonal therapy (combined therapy) as a standard of care for men with adenocarcinoma of the prostate that is locally advanced (stage T3 or T4) or high-risk localized disease (defined as one or more of the following: a prostate-specific antigen [PSA] level >20 ng per milliliter, a Gleason score [the sum of the two most common histologic patterns or grades in a prostate tumor, each of which is graded on a scale of 1 to 5, with 5 indicating the most aggressive . . .