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We typically refer to Advanced Disease as the state of prostate cancer that has grown beyond the prostate and is unlikely to be cured with surgery or radiation alone. After a man experiences PSA progression after surgery or radiation, hormonal therapy is often given at some point, and often for many years. Some men will not require any therapy, however, if their PSA doubling time is quite prolonged. However, many men will continue to progress at some point despite the above hormonal treatments and require more aggressive therapy. This comes in the form of additional second and third line hormonal therapies, investigational agents (many are in trials right now from new hormonal therapies to prostate cancer vaccines to bone-targeting drugs), and chemotherapy.