Intermediate risk prostate cancer is defined as: PSA 10-20ug/L; Gleason score 7; clinical stage T2b; Gleason score 7; high risk prostate cancer is defined as: PSA >20ng/mL; Gleason score ≥8; clinical stage ≥T2c; Gleason score ≥8. The latest version of the NCCN (National Comprehensive Cancer Network) recommends: intermediate-risk limited prostate cancer: radiation therapy +/- short-term depot treatment (4-6 months); high-risk limited prostate cancer: radiation therapy + long-term depot treatment (2-3 years); locally advanced prostate cancer: radiation therapy + long-term depot treatment (2-3 years) However, there are different voices about the NCCN recommendations to be expressed. Previously, surgery was not recommended for prostate patients with T3a or higher (prostate cancer invading outside the envelope), mainly because of the high positive margin rate, high lymph node metastasis rate and high possibility of recurrence of distant micrometastases. Recently, however, recent studies have shown that radical surgery for locally progressive prostate cancer improves overall survival and disease-free progression rates in this group of patients. Therefore, a study from the United States concluded that radical prostate cancer surgery can still be the first treatment modality for patients with very high-risk limited prostate cancer as long as the prostate tumor is not adherent to the pelvic wall and does not invade the external urethral sphincter. The main options in China are as follows: i. Continuous pharmacological debulking or surgical debulking; ii. Second-line endocrine therapy: 1. additional anti-androgen drugs; 2. intermittent anti-androgen therapy; 3. interchange of anti-androgen drugs: e.g. flutamide with bicalutamide; 4. adrenal androgen inhibitors or estrogens; iii. chemotherapy: 1. . polyene paclitaxel-based chemotherapy regimens; 2. mitoxantrone based chemotherapy regimens; 3. cabazitaxel; 4. clinical trial drugs (available in the US): abiraterone, enzalutamide, MDV3100, etc.