I. Overview We all know that clinically prostate cancer is classified into high risk, intermediate risk, and low risk based on PSA, Gleason score, and clinical stage in order to guide treatment and judge prognosis. According to the Prostate Cancer Strategic Collaborative Group, high-risk prostate cancer has accounted for 31.2% of new prostate cancers in the United States since 1991. The incidence of prostate cancer in China is much lower than that in Europe and the United States, but because the application of PSA screening is still imperfect in China, at least 35.8% of patients at the time of diagnosis mostly progress to high-risk prostate cancer. High-risk prostate cancer is difficult to treat because of its unpredictable biological behavior, great variation in clinical outcome, and a 5-year biochemical recurrence rate greater than 50%. II. Definition The current definition is: clinical stage ≥ T2c, or PSA > 20ng/ml, or Gleason score ≥ 8. Studies have shown that only patients with PSA > 20ng/ml have postoperative pathological stage 33% T2. 57.9% Gleason score < 7. 54% have negative cut margins. 85% have no lymph node metastasis. This group of patients could benefit from radical surgery. In contrast, PSA >20ng/ml and Gleason score ≥8. This group of high-risk patients hardly benefited from surgery. The value of surgical treatment in the management of high-risk prostate cancer Surgical treatment of high-risk prostate cancer, especially prostate cancer with clinical stage T3, is highly controversial, mainly because of inexact efficacy and higher perioperative complications. In the past, it was believed that high-risk prostate cancer was not suitable for surgery, preferring more conservative radical radiotherapy or endocrine therapy. In recent years, with further research on high-risk prostate cancer, especially the development of anatomical radical prostatectomy, surgical complications have significantly decreased and survival rates have greatly improved, making surgical treatment a renewed focus. Numerous retrospective studies have shown that postoperative pathology confirms the existence of staging overestimation in 13% to 27%. The 10-year biochemical recurrence-free rate after radical surgery for prostate cancer patients with clinical stage T3 was 51%, the tumor-specific survival rate was 91.6%, and the overall survival rate was 77%. Final pathology confirmed T2 in 23.5% and pT3b-4 in 20%. Statistical analysis showed that the differences in survival without biochemical progression and survival without clinical progression between pT3a and pT3b-4 were statistically significant. No such difference existed between pT3a and pT2. Thus patients at high risk for postoperative pT3a can still benefit from surgery. It has been shown that expanded pelvic lymph node dissection in radical surgery not only clarifies clinical staging but also significantly delays survival in patients with positive lymph nodes in the high-risk group Preoperative neoadjuvant endocrine therapy is not recommended for patients. Adjuvant endocrine therapy: It has been shown to delay the progression of high-risk prostate cancer but it is inconclusive whether it can improve the overall survival of patients. The local recurrence rate of pT3 prostate cancer is as high as 30%, and postoperative adjuvant radiotherapy is mainly for pT3 and margin positive patients. Immediate radiotherapy is currently advocated. In clinical work, whether to choose surgery or radiotherapy for high-risk prostate cancer is a question that clinicians need to face. A large retrospective study of high-risk prostate cancer showed that radical surgery and radical radiotherapy combined with adjuvant endocrine therapy had similar but better outcomes than radical radiotherapy alone. Compared with radical radiotherapy, radical surgery reduces the risk of distant metastases and tumor-specific morbidity and mortality in prostate cancer. Therefore, more aggressive surgery is currently favored if there are no contraindications to surgery.