High-risk prostate cancer (HRPCa) – defined by the NCCN as the presence of Gleason grade group 4-5 disease, clinical T stage 3-4, or PSA>20 – is an aggressive disease entity with a high risk of biochemical failure, up to 50% with extended follow-up. In recent years, we have learned that upfront management with external beam radiotherapy (EBRT), especially combined with brachytherapy (EBRT+BT), is one of the optimal strategies for definitive local therapy.1 While the natural history of high-risk prostate cancer is fairly well described 2 the natural history of clinical progression in men with radiorecurrent high-risk prostate cancer has not been well delineated.