Based on the PCG registry data, this is the largest study evaluating outcomes of 605 patients with localized high-risk prostate cancer (HRPC) treated with proton therapy. At a median follow-up of 22 months, the 3- and 5-year freedom from progression were 90.7% and 81.4%, respectively. Five-year metastasis free survival and OS were 92.8% and 95.9%, respectively. No grade 4 or 5 adverse events were reported. There were 23 (5%) grade 2 and 0 grade 3 GI events. The authors concluded that these early outcomes using proton therapy for HRPC were encouraging.