Kishan AU, Chu FI, King CR, et al. – Researchers performed an individual patient data meta-analysis of 6 randomized trials (593 participants in Gleason grade group [GG] 4 and 399 participants in GG 5) to assess the clinical implications of local failure (LF) following definitive radiotherapy. In high-grade localized prostate cancer (PCa) and a subset of distant metastasis (DM) events that were anteceded by LF events, LF was an independent prognosticator of overall survival, PCa-specific survival, and DM-free survival. LF events assured attention for intervention, possibly implying an explanation for upfront treatment intensification. Nevertheless, whether these findings apply to all men or just those without important comorbidity, remains to be elucidated.