UCSF

Key PointsPatients with high-risk prostate cancer have a significant chance of developing systemic or local recurrence, and are at higher risk for symptoms and/or death from the diseaseDefinitions vary for what constitutes high-risk disease in localized prostate cancer, but are historically based on clinicopathological findings including clinical stage, Gleason score, and PSAThe literature is limited as a consequence of variations in definition, lack of prospective randomized trials, limitations in statistical plan (underpowered studies), the need for long-term follow-up, and suboptimal end pointsSeveral key principles for radiotherapy have been established, including the importance of dose, and the addition of androgen-deprivation therapyOptimal surgical management requires completely removing the gland itself, confirming negative margins intraoperatively, and discussing the potential need for post-operative radiotherapyTreatment of potential lymph-node involvement, either surgically or with extended pelvic radiation, is favoured in high-risk disease, but lacks level I evidence