Management of Locally Advanced Prostate Cancer: A Scoping Review of Contemporary Evidence and Emerging Approaches

Locally advanced prostate cancers (LAPC) are a clinical dilemma due to their biological heterogeneity and multiple algorithmic treatment options. Recent years have seen a great deal of progress in management, both in established methods and new modalities. This had led to a necessity to systematically map out existing evidence. This scoping review intends to systematically integrate and summarize the zeitgeist research in the area of the care of LAPC to advance the available knowledge, discuss emergent management strategies, and identify evidence needs in different healthcare settings. A scoping review was undertaken following the Joanna Briggs Institute methodology and reported following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A primary study search was conducted on six electronic databases (MEDLINE, Embase, Scopus, Web of Science, CINAHL Plus, and Cochrane Library) and gray literature sources published between 2013 and April 2025. The Population-Concept-Context (PCC) framework guided the eligibility. Data were plotted and thematically synthesized into six key domains: hormonal therapy, radiotherapy innovations, surgical strategies, new systemic therapies, imaging improvements, and real-life evidence. Six studies were included, consisting of a randomized controlled trial, an observational study, and a diagnostic review. The main themes were the benefits of multimodal treatment, the impact of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) imaging and genomic profiling, and the role of second-generation androgen receptor inhibitors and regional disparities in access to treatments. Combination therapies showed oncologic benefits, but raised concerns about patients' quality-of-life outcomes. The management of LAPC is moving to a related precision-based, multimodal paradigm. Although current knowledge supports more aggressive and individualized therapy, there are still data gaps in long-term outcomes, global uptake, and patient-reported measures. Future research needs to be based on inclusive longitudinal studies that span between clinical innovation and real-world application.