[Localized prostate cancer at high risk of progression]

Localized prostate tumors have various clinical, biological and histopathological characteristics that lead to different progression profiles. High-risk prostate cancer has been classically defined by clinical examination, PSA levels and histopathological data. High-risk prostate cancer has usually a worse outcome, but classic stratification predictive of outcome for prostate cancer is a matter of debate concerning its accuracy. A great deal of scientific work have been deploy to prove that high-risk prostate cancer should be approached by teamwork including radio-hormone therapy, systemic treatment with long-term use of LH-RH and a radical prostatectomy with adequate lymph node dissection. Selection of patients is essential to define individualized therapeutic strategy and timing for every modality should come as a consensus of medical supported evidence. Accurate patient selection and multimodal treatment offer the best therapeutic option in high-risk prostate cancer.