OBJECTIVE: Different treatment modalities are considered in treating locally advanced prostate cancer in men. This review discusses the long-term follow-up data of patients who underwent radical prostatectomy with or without adjuvant therapy. The value of an (extended) pelvic lymphadenectomy in these patients is also discussed. METHODS: Relevant information was identified through a literature search of published studies and review articles. RESULTS: Radical prostatectomy alone in locally advanced prostate cancer seems to produce acceptable results. A nerve-preserving procedure in these patients, however, is not an option. Pretreatment with hormonal therapy does not seem to result in prolonged, progression-free or disease-specific survival. Adjuvant therapy after surgery seems to provide good survival rates. CONCLUSIONS: Although no guidelines exist for the treatment of high-risk prostate cancer patients, real benefit seems to occur from radical prostatectomy to control the local tumor and prevent morbidity associated with tumor growth. Since studies clearly demonstrated the benefits of adjuvant therapy along with radical prostatectomy, this should be the preferred course of action.