High-risk and locally advanced prostate cancer is characterized by substantial biological heterogeneity, with significant differences in recurrence risk, metastatic potential, and treatment response among patients, making it a major challenge in clinical practice. With the development of novel androgen receptor pathway inhibitors, PSMA PET/CT, multi-omics technologies, and artificial intelligence, overcoming the limitations of traditional risk stratification, accurately identifying patients at truly extremely high risk, and integrating local and systemic therapies to improve long-term outcomes have become important areas of research. Oncology Frontier · UroStream invited Professor Mo Zhang of the Department of Urology, First Hospital of China Medical University, for an in-depth interview on the institution's single-center experience, precision stratification strategies, and future research directions in high-risk and locally advanced prostate cancer.