How to cite: Khauli, Raja B. “Optimal Management of Patients Presenting with Locally Advanced Prostate Cancer in 2025.” September 15, 2025. Accessed Oct 2026. https://grandroundsinurology.com/optimal-management-of-patients-presenting-with-locally-advanced-prostate-cancer-in-2025/
Summary
Raja B. Khauli, MD, FACS, Professor of Urology and Surgery, American University of Beirut Medical Center, Beirut, Lebanon, Clinical Professor of Urology, Carle Illinois College of Medicine, Urbana-Champaign, Illinois, reviews contemporary management of locally advanced prostate cancer. He stresses the distinction between high-risk disease, characterized by extension beyond the capsule, involvement of the seminal vesicles, or invasion of adjacent structures, and advanced disease, noting that this distinction guides treatment decisions. This has implications for treatment selection.
Radiotherapy with androgen deprivation therapy (ADT) remains a cornerstone. Randomized data support the addition of androgen deprivation therapy with longer durations, improving survival compared with short courses. Local control can be enhanced with dose escalation using external beam boosts or brachytherapy. Systemic intensification with androgen receptor-targeted agents, such as abiraterone or enzalutamide, has demonstrated benefit in selected high-risk non-metastatic and low-volume metastatic settings.
Dr. Khauli shares that surgery is not always the standard treatment approach, due to advances in imaging and robotic techniques. Radical prostatectomy with extended pelvic lymph node dissection provides definitive pathology to guide selective adjuvant or early salvage therapy and is feasible in experienced centers. He awaits the results of the SPCG-15 trial comparing prostatectomy to radiotherapy plus ADT, and the PROTEUS trial evaluating apalutamide plus ADT before and after surgery.
Dr. Khauli emphasizes individualized care in a multidisciplinary setting. Radiotherapy with long-term ADT remains standard for many patients, while surgery and systemic intensification represent expanding options that can be integrated based on anatomy, biology, and patient priorities.
The Global Summit on Precision Diagnosis and Treatment of Prostate Cancer is a unique multi-disciplinary forum organized to inform the key health care stakeholders about the emerging advances in clinical case and research and create a consensus-based vision for the future of precision care and educational and research strategy for its realization. The mission of the Summit is to fill the currently existing gap between the key experts of in vivo imaging, the world authorities in the in vitro fluid- and tissue-based molecular diagnostics, including genomics, and thought leaders in the development of novel observation strategies (e.g., active surveillance, or AS) and therapeutic interventions.
ABOUT THE AUTHOR
Raja Khauli, MD, FACS is a Professor of Surgery and Urology at the American University of Beirut Medical Center, as well as Clinical Professor at the Carle Illinois College of Medicine in Urbana, Illinois. Dr. Khauli specializes in robotics and cancers including prostate, kidney, and bladder.
