Locally advanced prostate cancer can be reliably identified and has a disease-specific death rate of approximately 75%. Monotherapy treatment options have limited efficacy for locally advanced disease. Multimodality therapy may improve survival. This article reviews the current results of multimodality therapy, including hormonal therapy plus radiation therapy, hormonal therapy plus radical prostatectomy, and brachytherapy plus external-beam radiation therapy (EBRT), and presents current ideas for novel multimodality approaches.