The identification of patients with very high-risk prostate cancer at an early disease stage remains challenging. Now an analysis of micro-RNA (miRNA) expression patterns in patients with high-risk disease reveals a five-miRNA signature for the identification of such patients. The prognostic value of this panel was evaluated in a total of 28 patients, with a prognostic accuracy of ≥89% for each of the five miRNAs investigated. These data indicate a need for further clinical investigation.