The choice of prostate cancer treatment should take into account various factors such as clinical stage, life expectancy, health status, treatment risk, tumor grading, treatment cost and personal preference, among which the most important is the stage. The treatment method differs with different stages. With the popularity of PSA screening, the detection rate of early stage prostate cancer has gradually increased and the incidence of locally progressive stage T3 prostate cancer has significantly decreased. There is no uniform conclusion on whether stage T3 prostate cancer requires radical prostate cancer surgery. The goal of treatment for stage T3 prostate cancer is to “cure” the tumor as much as possible, prolong survival and improve quality of life. The current treatment options include radical resection, radiation therapy, endocrine therapy, and combination therapy. cThe results of radical prostatectomy for stage T3 prostate cancer have been the focus of much attention, but the results are not yet clear. For prostate cancer that is confined to the gland, good local tumor control can be obtained through radical prostatectomy; however, because the tumor of stage T3 prostate cancer has broken through the prostate envelope, many patients with clinical stage T3 prostate cancer have local dissemination, and it is more difficult to completely remove the tumor, the rate of positive surgical margins is higher, and there is a high rate of postoperative Walsh believes that for highly staged and high-grade tumors, no treatment can achieve radical cure. Most clinical studies currently oppose radical surgery for stage cT3 prostate cancer for the following reasons: (1) Radical surgery cannot completely remove the tumor that may break through the envelope, resulting in residual tumor that cannot be cured; (2) Although preoperative examination does not reveal lymph node metastasis, there is a high rate of lymph node metastasis for patients with stage cT3, especially for prostate cancer involving the seminal vesicles (2) Although lymph node metastasis is not detected on preoperative examination, there is a high rate of lymph node metastasis in patients with stage cT3 prostate cancer, especially for prostate cancer involving seminal vesicles, the rate of lymph node metastasis can be as high as 30%-50%, and local lymph node metastasis is an independent predictor for the prognosis of prostate cancer. The clinical progression rate can be 17-35% at 5 years after radical surgery. Geber et al. reviewed the prognosis of 298 patients who underwent radical prostatectomy and pelvic lymph node dissection at clinical stage T3 and found that the overall 10-year tumor-specific survival rate was only 57%. (4) The rate of positive incisional margins after radical resection varies with tumor stage, and the rate of positive incisional margins after radical resection for stage T3 prostate cancer is significantly higher than that for stage T2 tumors. Han et al. reported that from 1982 to 2001, the detection rate of positive incisional margins after surgery for limited prostate cancer gradually decreased from 40% to a recent rate of 10%, while in the past 10 years, the incisional margin rate in T3 patients The positive rate has largely remained above 20% with no significant decline. The Johns Hopkins Research Center reports confirm this finding, with cut edge positivity rates of 24.2%-80% in those with T3 and beyond. Clinical studies have shown that a positive cut margin is an important risk factor for recurrence of prostate cancer after surgery and often implies a poor prognosis . (5) Although there is a lack of research on urinary control, erectile function and quality of life after radical surgery for stage T3 prostate cancer, the functional regression of locally progressive prostate cancer after radical surgery is unclear, however, because the tumor has broken through the envelope, surgeons are bound to remove more tissue than in limited prostate cancer when performing surgery, considering the goal of complete tumor removal, which will undoubtedly This will undoubtedly lead to an increased incidence of urinary incontinence, erectile dysfunction and other complications, and the patient’s quality of life cannot be guaranteed. For these possible reasons, the rate of radical prostatectomy has declined in recent years, and radical prostatectomy for locally progressive prostate cancer has become increasingly rare. data from Meltzer et al [14] showed that 30% of newly diagnosed cT1-2 stage prostate cancer was treated with radical surgery, and only about 67% of young patients with long life expectancy were treated with radical surgery; while only 6% of cT3 stage prostate cancer was treated with radical surgery. Only 6% of stage cT3 prostate cancers are treated radically. Ward et al. reported that the proportion of stage cT3 prostate cancer undergoing radical resection decreased from 25% in 1987 to 2.8% in 2001. This change is due to the recognition that radical prostatectomy alone is usually not sufficient to cure locally progressive prostate cancer. The results showed that except for a small percentage of T2 or some low-grade T3, surgery or radiation therapy alone cannot cure cT3 prostate cancer and its efficacy is not superior to endocrine therapy. On the other hand, the development of radiotherapy techniques and the recognition of less invasive combination therapies (e.g., radiotherapy and antiandrogen therapy) have led to a significant expansion of treatment modalities for locally progressive prostate cancer. denberg et al. attributed the marked improvement in the control of local progression of stage cT3 prostate cancer in recent years to the decrease in radical surgery and the increase in external radiation therapy. Since nearly half of the patients with stage T3 prostate cancer have lymph node involvement, most scholars believe that combination therapy should be used. Combination therapy includes: (1) radiation therapy combined with endocrine therapy: studies have shown that the combination of the two has a better therapeutic effect; (2) radical prostatectomy combined with endocrine therapy. Neoadjuvant endocrine therapy has not shown significant advantages, but adjuvant endocrine therapy can improve local control rates and disease-free progression survival. Radical prostatectomy combined with adjuvant radiation therapy has no significant advantage. The National Cancer Institute recommends external radiation therapy combined with adjuvant endocrine therapy as the treatment of choice for cT3 stage prostate cancer. The European Association of Urology reports that external radiation therapy combined with adjuvant endocrine therapy for prostate cancer is gradually gaining majority acceptance. Thus, the trend in the treatment of locally progressive prostate cancer is toward non-surgical treatment or combined treatment including surgery, while radical prostatectomy may be beneficial only for some selected patients with low-risk locally progressive prostate cancer.