There is increasing evidence for the role of radical prostatectomy in select patients with T3-T4 prostate cancer (as part of multimodal therapy). This retrospective multicentre study explored the benefit of neoadjuvant hormonal therapy before radical prostatectomy specifically in patients with high-risk prostate cancer. One thousand, one hundred and seventy patients who underwent radical prostatectomy alone were compared to 403 patients who underwent neoadjuvant hormone therapy and radical prostatectomy. The addition of neoadjuvant hormone therapy offered an advantage (hazard ratio, HR 0.5) for deaths from prostate cancer (but not overall mortality). This finding did appear linked to patients who subsequently underwent adjuvant radiotherapy: prostate cancer related deaths in patients who underwent neoadjuvant hormones, radical prostatectomy and adjuvant radiotherapy 2.3% at five years vs. 7.5% at five years with radical prostatectomy and adjuvant radiotherapy alone. The conclusions are limited by the retrospective nature of the study but they do shed light on the optimal management of patients with non-metastatic T3-T4 high risk prostate cancer.