Patients with prostate cancer (PC) with clinically positive lymph nodes detectable via conventional imaging have always been perceived as a challenge, especially with regard to the value of applying local treatment. Over the years, many of these patients have been treated with androgen deprivation therapy (ADT) only. Studies in this specific setting are scarce and mostly retrospective. This issue of European Urology Oncology contains a systematic review of the role of local treatments in this patient population by Ventimiglia et al.