High-risk prostate cancer is a more aggressive form of the disease with a significantly increased chance of progression, recurrence, and metastasis. It is defined by one or more of the following criteria:

-PSA >20 ng/mL

-Gleason score 8–10 (Grade Group 4 or 5)

-Clinical stage T3a or higher (tumor extends through the prostate capsule)

Patients with high-risk prostate cancer often require multimodal treatment, including radiation therapy combined with long-term androgen deprivation therapy (ADT) (typically 18–36 months), or radical prostatectomy with possible adjuvant or salvage therapy. This group carries a higher risk of cancer spreading beyond the prostate, and management is typically more aggressive to improve long-term survival.