Prostate cancer: Adjuvant and salvage therapies following primary local therapy

Prostate cancer frequently has a long natural history and may remain in the pelvic region (prostate, seminal vesicles, periprostatic tissues and pelvic lymph nodes) for many years before metastasizing to upper eschelon lymph nodes, bone or other distant sites. The lengthy pelvic phase of the disease makes prostate cancer amenable to multiple local therapies in many cases. Systemic therapy can also be employed during this pelvic phase of the disease in an effort to prevent or delay metastatic disease and improve survival. Local control of prostate cancer during this pelvic phase of the disease is strongly associated with improved prostate cancer survival. Failure to control the disease in the pelvis can result in debilitating local symptoms, higher risk of developing distant metastatic disease and shortened survival. This review will focus on how multiple local or systemic therapies may be combined to optimize local control and survival.