Prognostic Significance of High-Risk versus Very High-Risk Classification in Non-Surgically Managed Prostate Cancer: A Retrospective Cohort Study

Our findings show that the VHR classification maintains strong prognostic value even in non-surgically managed patients, underscoring its role as a biologically distinct and aggressive disease entity. Standard RT+ADT seems insufficient in this subgroup. The study supports exploring intensified treatment strategies, such as prolonged ADT, brachytherapy boost, pelvic nodal RT, and, where appropriate, novel androgen receptor signaling inhibitors or chemotherapy.