Prostate cancer management: 2. An update on locally advanced and metastatic disease.

Just under half of men with prostate cancer present with locally advanced or metastatic disease. A multidisciplinary approach is required to improve survival, minimise complications, and provide adequate palliation. Radiotherapy remains the mainstay of treatment for pelvic disease control and encouraging results have been reported with androgen ablation as adjuvant therapy. In metastatic disease androgen ablation is usually first line, although ultimately most tumours become hormone refractory, requiring second or third line treatments. Localised or systemic radiotherapy may be used for palliation in metastatic disease. With the advent of more potent bisphosphonates the common bony complications associated with metastases may be reduced. This, the second review of prostate cancer, explores the various treatments available to the multidisciplinary team.