Benefits and Risks of Primary Treatments for High-risk Localized and Locally Advanced Prostate Cancer: An International Multidisciplinary Systematic Review

High-risk and locally advanced prostate cancer (PCa) patients are likely to undergo multimodality treatment. Patients should at all times be fully informed about all available options and the likelihood of a multimodal approach, including the potential side effects of both local and systemic treatment. For high-risk localized and locally advanced PCa, both radical prostatectomy as part as multimodal therapy and external beam radiotherapy (EBRT) + long-term androgen deprivation therapy (ADT) can be recommended as primary treatment. For high-risk localized PCa, EBRT + BT can also be offered despite a less favorable toxicity profile. In selected high-risk PCa patients, a shorter duration of ADT might be considered. Until the results of the SPCG15 trial are known, the optimal local treatment remains a matter of debate.