Surgical Management of High-Risk Prostate Cancer

High-risk prostate cancer (HRPCa) is a heterogeneous disease with variable presentations and outcomes. While radiotherapy with androgen deprivation therapy was historically favored, radical prostatectomy (RP) is now increasingly employed as a primary treatment. Emerging evidence supports RP as an effective option in select patients, potentially avoiding the adverse effects of combined therapy. Advances in imaging and surgical techniques allow for more personalized surgical care in HRPCa, thereby reducing RP morbidity without compromising oncologic control. Ongoing trials are evaluating the role of RP within a multimodal therapy approach and will provide data on the optimal treatment of HRPCa.