<p>We comment on the recent study by Fröhlich et al., which evaluated the influence of adherence to multidisciplinary tumor board (MDT) recommendations on oncological outcomes in high-risk prostate cancer patients following radical prostatectomy. While this study contributes valuable real-world data, we highlight several limitations. Notably, psychosocial factors influencing adherence, such as fear of toxicity and socioeconomic concerns, were not addressed. Additionally, selection bias may have influenced the observed benefits of adjuvant radiotherapy, warranting the use of propensity score methods in future analyses. Finally, the lack of improvement in overall survival despite better biochemical recurrence-free survival raises questions about the clinical relevance of surrogate endpoints. We advocate for broader, patient-centered approaches and methodological rigor in future investigations.</p>