How do you manage an elderly, high risk prostate cancer patient who refuses any local therapy?  

In general, for patients who refuse treatment, I try to understand their goals and their fears. Often, elderly patients state that they are ready to die, and don't want to prolong their lives. If I think that treatment is likely to significantly improve the quality of their lives, I will explain why...

Certainly, understanding of patient goals is foremost here - why are they not considering local therapy with a 5-10 year life expectancy? What are their fears- what risk are they willing to tolerate of morbidity from progression and hormonal therapy to avoid treatment now? Aside from that, TOAD sugg...

The only thing I can add in addition to the previous answers is I frequently have a frank discussion with the patient as to what "dying OF prostate cancer" (as opposed to "dying WITH prostate cancer") means for most patients. This includes discussion about the (eventually) painful bony metastases an...

Patients are to be informed of reasons for treatment and accept their decision not to be treated.