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Commonly used high-risk prostate cancer definitions, based on preoperative clinico-pathological findings, are useful but insufficient for stratifying patients’ risk of poor outcome. Therefore, several nomograms have been developed to improve the predictive value of these preoperative findings. The future for further sub-stratification and personalised medicine, however, lies within the development of biomarkers. Conclusion Prostate cancer remains the most frequently diagnosed cancer among men and high-risk prostate cancer represents an important subgroup. When diagnosed with high-risk prostate cancer, mortality rates are high if patients do not undergo treatment with curative intent. The future lies in the development of novel biomarkers, optimising pre-treatment risk stratification and identifying the true ‘high-risk prostate cancer patient’.

The role of surgery as active treatment for high risk localized prostate cancer seen from an epidemiological perspective