The treatment of locally advanced prostate cancer is still matter of debate. While many years ago hormonal treatment (HT) was mostly applied, in recent years the combination of radiotherapy (RT) and HT has been more and more advocated. However, this treatment has never been shown in randomized controlled trials to be superior to surgery without or with adjuvant HT. The surgical approach by radical prostatectomy (RP) has often been discouraged although the results of RP in monotherapy for well-selected patients are excellent. Improvement in staging, a better selection of patients and expert surgery with extensive resection make RP a valuable adjuvant treatment option. Adjuvant therapy with either radiation or hormones can still be applied depending on the definitive pathology of the resected specimen.