Radical prostatectomy is a potential first-line treatment for high-risk prostate cancer, especially in younger, healthy patients seeking curative therapy. The surgery involves removal of the prostate gland and often includes a pelvic lymph node dissection to assess for cancer spread.

While surgery alone may be curative in select cases, many high-risk patients require multimodal therapy, including adjuvant or salvage radiation and possibly androgen deprivation therapy (ADT) based on postoperative findings (e.g., positive margins, seminal vesicle invasion, or lymph node involvement). Radical prostatectomy provides definitive pathological staging, which helps guide further treatment. However, it carries risks such as urinary incontinence and erectile dysfunction, which must be balanced against the benefits of aggressive cancer control.