Background: Data on HR LPC patients treated with RP and perioperative HT is lacking in the Asia-Pacific (AP) region. Thus, this study aimed to describe the real-world clinical characteristics and treatment patterns of this group of patients in Japan, South Korea, and Taiwan. Methods: A retrospective observational study was conducted, utilizing data from chart review at five sites in Japan and data from electronic medical records of three medical centers in Korea and a multi-hospital system in Taiwan. Eligible patients were adults ≥18 years who were newly diagnosed with prostate cancer between 1 January 2015 and 30 June 2017 and had exactly one high-risk feature as per NCCN prostate cancer guidelines: cT3a; Gleason Grade Group 4 or 5; prostate-specific antigen (PSA) >20 ng/mL. Patients also received RP during the same period and had ≥3 months neoadjuvant HT and/or ≥6 months adjuvant HT. Data on clinical characteristics and treatments were collected. Patient data till 30 June 2022 was included, where possible. Considering differences in data collection methodology and clinical practice, data for Japan were reported separately from Korea and Taiwan. Results: There were 354 newly diagnosed HR LPC patients across sites in Japan and 677 newly diagnosed HR LPC patients across sites in Korea and Taiwan. Of these patients, 72.6% (n=257) of patients in Japan and 72.4% (n=490) of patients in Korea and Taiwan received RP. A total of 72 (20.3%) HR LPC patients in Japan and 33 (4.9%) HR LPC patients in Korea and Taiwan who received RP and perioperative HT were eligible for inclusion into this study. In the Japan cohort, 95.8% (n=69) of patients received neoadjuvant HT with RP and the median duration of neoadjuvant HT was 7.1 months. In the Korea and Taiwan cohort, 93.9% (n=31) of patients received adjuvant HT with RP and the median duration of adjuvant HT was 11.2 months. The median duration of follow-up was 11.7 months and 71.8 months in the Japan cohort and Korea and Taiwan cohort, respectively. The median age of patients was 73.5 years in the Japan cohort and 67.8 years in the Korea and Taiwan cohort. In both cohorts, majority of patients had cT3a (Japan: 44.4%; Korea and Taiwan: 42.4%) and one-third (33.33%) of patients had Gleason grade group 4 or 5 at LPC diagnosis. The median PSA at LPC diagnosis was 9.3 ng/mL in the Japan cohort and 11.1 ng/mL in the Korea and Taiwan cohort. Conclusions: This study revealed that while the proportion of HR LPC patients receiving RP was similar within the AP region, clinical practice on the use of perioperative HT differed. The proportion of HR LPC patients receiving RP in the AP region was higher compared to the United States in 2013 (42.0%). Globally, studies on the use of perioperative HT as part of a multi-modal therapy are ongoing to discover an optimal strategy for the management of HR LPC patients.