 The American Cancer Society estimates that approximately 29,480 men will die of prostate cancer in the United States in 2014. Many of these men were initially diagnosed with aggressive prostate cancer so-called high risk prostate cancer, often with cancer that extended beyond the prostate gland itself or was of a high Gleason score, or was associated with a Prostate Specific Antigen PSA level 20 ngml. In contrast to the more favorable outcomes in men with low and intermediate risk disease, nearly 50 of men with high-risk prostate cancer will have a recurrence of their cancer despite a complete course of treatment. One of the mainstays of care for men with high-risk prostate cancer is a combination of radiation therapy and hormone suppression more appropriately called androgen deprivation ADT. Despite advances, a clear need exists for improved clinical management of high risk disease. 