Continuous advances have provided a new understanding of the diagnosis, staging, and treatment of metastatic and advanced prostate cancer. The earlier definition of advanced disease (bone metastasis and soft-tissue involvement) has also been improved.

Prostate cancer is the most commonly diagnosed cancer and the second leading cause of cancer-related deaths in men in the United States. ^[1]Most prostate cancer–related deaths are due to advanced disease, which results from any combination of lymphatic, hematogenous, or contiguous local spread.

This article provides an overview of the current modalities available in the treatment of advanced prostate cancer, highlighting the following points:

• Identification of the population at risk of developing advanced prostate cancer
• Evolution of clinical staging and therapeutic options currently available to these patients
• Controversies surrounding early versus delayed treatment and combined androgen blockade (CAB)
• Definition and management of biochemical failure
• Hormone-refractory prostate cancer

The most important and established prognosticators for prostate carcinoma include the Gleason grade, the extent of tumor volume, and the presence of capsular penetration or margin positivity at the time of prostatectomy.

High-grade prostate cancer, particularly the percentage presence of Gleason grades 4 and 5, is associated with adverse pathologic findings and disease progression. Conversely, low-grade prostate tumors can also be biologically aggressive.

Patient education

Family counseling for a terminally ill patient with an anticipated poor outcome is crucial to avoid any unreasonable expectations from arising. In addition, any experimental treatment modalities must be clearly outlined, with risks and potential benefits.