Prof Bertrand Tombal (Université Catholique de Louvain, Brussels, Belgium), Prof Thomas Steuber (University Medical Center Hamburg-Eppendorf, Hamburg, Germany), Prof Gert Attard (University College London Cancer Institute, UK) and Dr Mary-Ellen Taplin (Dana-Farber Cancer Institute, Boston, USA) discuss recent changes in the management of high-risk localised prostate cancer, with a focus on the role of surgery and how emerging clinical trial data may influence treatment decisions.

The panel reviews findings from the PROTEUS and STAMPEDE trials, alongside the DASL-HiCaP study, and discusses treatment options including radical prostatectomy, radiotherapy, androgen deprivation therapy (ADT), and androgen receptor pathway inhibitors such as apalutamide, darolutamide and abiraterone.

The experts consider the benefits of treatment intensification, the potential need for multimodal approaches and how to select the most appropriate local treatment for individual patients.

The discussion also explores patient risk stratification using PSMA PET imaging and molecular classifiers, which may help identify patients most likely to benefit from treatment intensification and those who could avoid unnecessary treatment.

The panel considers the challenges of applying clinical trial findings to different risk groups, balancing treatment efficacy with side effects, and choosing therapies based on patient preferences, tolerability, cost and availability.