Is there a role for radical prostatectomy in the management of oligometastatic prostate cancer? A systematic review

Context:There is a growing interest about the role of radical prostatectomy (RP) in local cancer control in oligometastatic prostate cancer (PCa).Purpose:To evaluate the oncological and functional outcomes of RP in the management of oligometastatic PCa through a systematic review.Methods:A systematic review search was performed and the following bibliographic databases were accessed: PubMed, Scopus, Embase and the Cochrane central register of controlled trials were searched from January 2000 to November 2022. This was carried out by the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines.Results:Based on the literature search of 384 articles, 11 (511 patients) met the inclusion criteria (mean age: 65.5 yr.). Positive surgical margins were 59%. Median follow-up ranged from 13 to 64 months. Clinical progression-free survival ranged from 56% at 3 years to 45% at 7 years. Specific and overall survival rates ranged from 60 to 80.5% and 78 to 80% at 5 years, respectively. Clavien >= 3 complications ranged from 0 to 21%. The urinary incontinence rate was 14.5%.Conclusions:Similar to published studies, RP of oligometastatic PCa appears to be safe with acceptable morbidity in selected patients. The lack of a consensual definition, the low level of evidence and the bias of the comparative and retrospective studies available do not allow practical recommendations to be made. There is currently no place for metastatic surgery outside of participation in a clinical trial.