New surgical approaches for clinically high-risk or metastatic prostate cancer. 
A considerable number of individuals with prostate cancer (PCa) still harbor locally-advanced and metastatic disease.  Although such men were initially not considered eligible for local treatment, the role of radical prostatectomy (RP) has been recently reassessed.  Areas covered: This review analyses currently published evidences regarding new surgical approaches for clinically high-risk PCa individuals, as well as the role of cytoreductive surgery in the metastatic setting.  The role of robot-assisted radical prostatectomy (RARP) and extended pelvic lymph node dissection will be evaluated with regards to perioperative, oncologic, as well as functional outcomes.  Expert commentary: RARP is a feasible approach in PCa patients regardless of the presence of high-risk disease features and can achieve optimal short-term oncologic outcomes and acceptable short/intermediate-term functional outcomes, that are comparable to those reported for open RP.  Extended pelvic lymph node dissection can be performed in this setting and should be recommended for all high-risk PCa patients.  The overall rate of complications in contemporary men treated with RARP for high-risk disease is not negligible.  Cytoreduction in the oligo-metastatic setting is feasible and relatively safe, although evidence is scarce to recommend its widespread adoption.  In consequence, longer follow-up data and, ideally, randomized controlled trials are needed.