Dr. Spratt ponders the evolving integration of RT with systemic treatments, challenges in counseling patients, and more. Prostate-specific antigen density was the only clinical variable significantly associated with csPCa other than PI-RADS 5. Dr. Canfield shares real-world active surveillance among men with localized PC tested with the genomic prostate score assay. The 17-gene GPS assay can help physicians with clinical management plans for patients with localized PC. cN1 patients with PCa who undergo initial treatment with RT have worse PCSM outcomes than those treated with RP. Dr. Spratt reviews the safety and efficacy of relugolix plus RT in patients with localized or advanced prostate cancer. Dr. James Sylora shares his career, patient care, and vision for surgical and therapy advancements in community urology. Relugolix was approved in 2020 for the treatment of localized prostate cancer based on the efficacy seen in the HERO trial. Part 1 of the new guidelines covered treatment decision-making during suspected BCR following radical prostatectomy. Recommendations were included for patients with biochemical recurrence following radiation therapy. Dr. Calais explains the utility of PSMA PET prior to RT for unfavorable intermediate-risk or high-risk prostate cancer. Radical prostatectomy resulted in worse urinary incontinence for patients with localized prostate cancer. Dr. Eggener describes the Stockholm3 test and reasons for validating it in an ethnically-diverse population. No G3 or G4 GU or GI toxicities occurred in either treatment arm, and G2 toxicities were uncommon. Drs. Freedland and Wallis continue their EMBARK discussions and recommendations for treating high-risk BCR prostate cancer. Drs. Freedland and Wallis discuss the details of the NEJM phase 3 EMBARK study on enzalutamide in BCR prostate cancer. Enzalutamide plus leuprolide and enzalutamide monotherapy resulted in significantly MFS and a longer time to PSA progression. Drs. George and Wallis discuss applications and counseling patients on focal therapy, as well as post-treatment follow-up. Enzalutamide plus leuprolide acetate and enzalutamide alone caused delayed MFS when compared with placebo plus leuprolide. The FDA approved enzalutamide as the first AR-signaling inhibitor for the treatment of nmCSPC with high-risk BCR.