Radical prostatectomy may be considered for select patients with locally advanced prostate cancer (typically stage T3a, and occasionally T3b), but it is generally reserved for younger, healthy men with a strong preference for surgical treatment and no evidence of distant metastasis.

Because locally advanced disease extends beyond the prostate capsule or into the seminal vesicles, surgery is often combined with extended pelvic lymph node dissection and may be followed by adjuvant or salvage radiation therapy, depending on pathology results (e.g., positive margins, extracapsular extension, or lymph node involvement).