- PSA >20
- Gleason 4+4 or 4+5, more than 5 cores
- Clinical Exam: Abnormality that extends beyound the prostate with no fixation
These men have a much higher risk of recurrence with surgery or radiation or surveillance, and often benefit from more aggressive combination approaches.
- Open Radical Prostatectomy
- Robotic Radical Prostatectomy
- Radiation Therapy and 2- 3 years of hormonal suppresion
- Watchful Waiting