The 5-year results of neoadjuvant androgen suppression and external beam radiation therapy for locally advanced prostate cancer show a benefit in local, distant, and biochemical control when compared with external beam radiation therapy alone. Further follow-up will ascertain if these findings translate into a survival benefit. Combined modality staging is a methodology in which all of the pretreatment clinical factors that are found to have independent prognostic significance on multivariable analysis for predicting a given outcome (for example, pathologic stage) are used to determine the initial management. This method of staging is able to provide an optimized assessment of the pathologic extent of local disease prior to management, and therefore it is better able to define those patients in whom local-only therapy is likely to be curative. Knowing more reliably the pathologic extent of disease prior to therapy also provides a rationale for patient selection in clinical trials that are currently testing the impact on overall survival of combining androgen suppression and external beam radiation therapy for early stage (T1b-T2b) prostate cancer.