Patients with high-risk prostate cancer have a greater risk of biochemical recurrence, metastasis, the need for additional therapies, and prostate cancer-specific mortality. Although robot-assisted laparoscopic radical prostatectomy has largely supplanted open surgical approaches in localized low-risk disease, its role in the high-risk setting is still controversial, as evidence from the literature is limited. The aim of the following chapter is to summarize contemporary evidence from currently available data.