The definition of high risk prostate cancer is unclear. Generally preoperative PSA, Biopsy Gleason score and DRE characteristics are used to describe this group of patients. But until now, there is no consensus for these prostate cancers and manystudies report different methods of classification and different treatment options, ranging from hormonal therapy to prostatectomy. Thus, there is a need to clarify the definition and treatment of high risk prostate cancers, especially localized prostate cancer with high PSA. Herein we review the literatures on high risk prostate cancers and their oncologic outcomes