Widespread use of testing for prostate-specific antigen (psa) has led to a migration in the stage and grade of prostate cancer (pca), with most men presenting with localized disease. However, 20%-35% of patients still present with high-risk disease (psa > 20 ng/mL, biopsy Gleason score 8-10, or clinical stage T3). Despite advances in various treatment modalities, patients with high-risk disease have a significant chance of recurrence and death after surgery, often because of the presence of

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... y occult metastasis at time of diagnosis. The optimal management of high-risk pca remains controversial. The present article aims to discuss the traditional approaches and the more recent evolution toward multimodal therapies. KEY WORDS Urology, prostate cancer