INTRODUCTION: The aim of this review was to summarize the available evidence on the role of metastasis-directed therapy (MDT) and/or prostate-targeted therapy (PTT) in the setting of oligometastatic prostate cancer (PCa). EVIDENCE ACQUISITION: We searched PubMed, the Web of Science, and the Cochrane Library databases. The following keywords were used: ("prostate cancer" OR "prostate carcinoma" OR "prostate neoplasm" OR "prostate tumor") AND ("oligometastatic" OR "oligometastasis" OR "PSMA") AND ("surgery" OR "prostatectomy" OR "radical prostatectomy" OR "cytoreductive" OR "local treatment" OR "radiotherapy" OR "stereotactic" OR "stereotaxic") AND ("survival" OR "mortality"). EVIDENCE SYNTHESIS: After evaluating the selection criteria, 81 studies were evaluated for our endpoints. We included 22 studies for PTT of synchronous mPCa. There have been no randomized studies on cytoreductive prostatectomy (cRP). Four prospective studies showed that cRP was feasible but did not contribute to a positive effect on overall survival (OS). Regarding PTT-radiotherapy, two randomized controlled phase 3 trials showed that OS was improved in men with a low metastatic burden. Regarding MDT of metachronous lymph node recurrence, we included 29 retrospective studies. For MDT of oligometastases, we included 30 studies. One randomized phase 2 trial showed that androgen deprivation therapy-free survival improved with stereotactic body radiation therapy compared to that with surveillance; however, benefits on OS remain unclear. CONCLUSIONS: We performed a comprehensive overview of the current literature on MDT and PTT. The feasibility of MDT and PTT is supported by several retrospective studies. Nevertheless, there remains a lack of high-quality trials to prove its survival benefits. Results from ongoing prospective trials data are awaited.

Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Urology Campus Bio Medico University Rome Italy

Department of Urology Clinique Pasteur Toulouse France

Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria

Department of Urology Ehime University Graduate School of Medicine Ehime Japan

Department of Urology Erasme Hospital University Clinics of Brussels University of Brussels Brussels Belgium

Department of Urology King Fahad Specialist Hospital Dammam Saudi Arabia

Department of Urology The Jikei University School of Medicine Tokyo Japan

Department of Urology University Hospital of Tours Tours France

Department of Urology University of Jordan Amman Jordan

Department of Urology University of Texas Southwestern Dallas TX USA

Department of Urology Weill Cornell Medical College New York NY USA

EAU Young Urologist Office Arnhem the Netherlands

European Association of Urology Research Foundation Arnhem the Netherlands

European Society of Residents in Urology Arnhem the Netherlands

Institute for Urology and Reproductive Health Sechenov University Moscow Russia

Karl Landsteiner Institute of Urology and Andrology Vienna Austria

Research Center for Evidence Based Medicine Tabriz University of Medical Sciences Tabriz Iran

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