Moris L, Cumberbatch MG, Van den Broeck T, et al. - An international multidisciplinary systematic review was conducted to evaluate the different primary treatment modalities for high-risk localized and locally advanced prostate cancer (PCa). The primary oncological endpoint was the development of distant metastases at ≥ 5 yr of follow-up. PCa-specific mortality, overall mortality, biochemical recurrence, and need for salvage treatment with ≥5 yr of follow-up were included as secondary oncological endpoints. They searched Medline, Medline In-Process, Embase, and the Cochrane Central Register of Randomized Controlled Trials. For the primary treatment of high-risk and locally advanced PCa, both RP as part of multimodal treatment and EBRT + long-term ADT can be recommended. EBRT + BT can also be offered despite more grade 3 toxicity for high-risk PCa. Interestingly, for selected individuals, for example, those with higher comorbidity, a shorter duration of ADT might be an option. EBRT + BT gives promising results but still requires further validation for locally advanced PCa. The optimal local treatment remains a matter of debate until the results of the SPCG15 trial are known.