Complications of locally advanced prostate cancer are often overlooked in the overall treatment of prostate cancer, can have significant morbidity, and can provide a challenge for the treating urologist. Despite advances in early detection and treatment of prostate cancer, as many as 10% of patients present with or develop symptomatic locally advanced prostate cancer. Prostate cancer locally invading the urethra can be effectively managed with transurethral resection or ablation procedures or urethral stenting. Obstruction of one or both ureters is managed with either ureteral stenting or nephrostomy drainage. Bulky pelvic recurrence resulting in significant hematuria, rectal involvement, or severe pelvic pain can be difficult to manage, with some advocating cystoprostatectomy or pelvic exenteration to provide palliation. Surgical intervention for locally advanced prostate cancer can provide significant improvement in quality of life and should not be restricted to patients who have curable disease.