The standard treatment for locally progressive prostate cancer has been endocrine therapy or endocrine therapy + radiotherapy. Surgery is not advocated, mainly because radical surgery increases the risk of positive margins and because of the high incidence of positive lymph nodes and distant metastases in this stage of the disease. Several randomized studies have confirmed the superiority of combined radiotherapy and endocrine therapy over radiotherapy alone, but there are no randomized studies comparing combined therapy with surgery. In addition, the use of postoperative adjuvant radiotherapy and adjuvant endocrine therapy in most clinical studies adds to the difficulty of analysis and the complexity of the study. Despite the controversy, studies on the surgical treatment of locally progressive prostate cancer have been increasing in recent years. As previously mentioned, reasons for recommending radical surgery include the existence of multiple degrees of staging in many prostate cancers, which deprives some patients suitable for radical surgery of the opportunity to operate, surgery provides accurate staging of prostate cancer to facilitate further treatment and determine prognosis, and surgery plus debulking helps the prognosis of patients with positive lymph nodes. For radical surgery for clinically progressive prostate cancer, whether open surgery or minimally invasive surgery, good surgical skills and proficiency are required to control the complication rate, and the accumulation of surgical experience can help reduce surgical complications and improve postoperative functional recovery, and it has been reported that urinary control can be preserved in most patients with stage T3 tumors, and sexual function can be preserved in some patients. On the basis of fully informed consent, treatment of stage T3a prostate cancer needs to be combined with the patient’s subjective wishes. Despite the late clinical stage, psychologically many patients are more willing to accept surgical resection of the tumor and further adjuvant therapy to achieve a complete treatment process, and combination therapy is psychologically difficult for this group of patients to accept. On the contrary, due to the inevitable trauma and sexual function impact brought by surgical treatment, it will restrict some patients to choose surgery to achieve local treatment of tumor, and at this time, combination therapy is more suitable for this part of patients. In the domestic situation, there is still a big gap between our radiotherapy technology and European and American countries, and there are not many clinical centers that use radiotherapy to achieve the ideal local treatment of tumor. In comparison, the quantity and quality of radical prostate cancer surgery is better than radiation therapy, and even in some centers laparoscopic radical prostate cancer surgery as a routine has replaced traditional open surgery, and the treatment effect of prostate cancer tumor and postoperative functional recovery are comparable to open surgery. Therefore radical prostate cancer surgery is currently the main treatment for stage T3a tumors in China. However, comparing the effects of surgical treatment and combined treatment for locally progressive prostate cancer requires the establishment of a scientific research system. On the one hand, there is an urgent need for the promotion and development of radiotherapy technology, and on the other hand, there is a need for multicenter cooperation, with more patients included in randomized controlled studies to establish long-term patient follow-up data, which is an urgent problem we need to address at present.