Despite growing interest in metastasis-directed therapy (MDT) for prostate cancer (PCa), little is known regarding the feasibility and effectiveness of surgical metastasectomy for isolated lesions. We performed a narrative review of the available evidence supporting metastasectomy for M1b-c lesions in men diagnosed with oligometastatic or oligorecurrent PCa. The case series and case reports we identified indicate that surgical MDT is a safe and feasible treatment option for well-selected patients with a small number of PCa metastases diagnosed via molecular imaging. It is difficult to draw evidence-based conclusions regarding the survival benefit of metastasectomy; however, metastasectomy might lead to a prostate-specific antigen response and could potentially delay systemic therapy in patients with oligometastatic PCa. Prospective studies incorporating novel imaging are needed to better establish the role of metastasectomy for patients with metastatic PCa. PATIENT SUMMARY: We reviewed the evidence on surgical removal of prostate cancer lesions that have spread to the organs (eg, liver and lung) or bone, which are called metastases. Limited results show that this approach is feasible and has favorable outcomes in selected patients.

Department of Urology Medical University of Silesia Zabrze Poland; Department of Urology Medical University of Vienna Vienna Austria

Department of Urology Medical University of Vienna Vienna Austria

Department of Urology Medical University of Vienna Vienna Austria; Department of Urology 2nd Faculty of Medicine Charles University Prague Czechia; Hourani Center for Applied Scientific Research Al Ahliyya Amman University Amman Jordan; Institute for Urology and Reproductive Health Sechenov University Moscow Russia; Department of Urology Weill Cornell Medical College New York NY USA; Department of Urology University of Texas Southwestern Dallas TX USA

Department of Urology Medical University of Vienna Vienna Austria; Department of Urology The Jikei University School of Medicine Tokyo Japan

Department of Urology Medical University of Vienna Vienna Austria; Department of Urology Uro Oncology Robot Assisted and Specialized Urologic Surgery University Hospital Cologne Cologne Germany

Department of Urology University Hospitals Leuven Leuven Belgium

Unit of Urology Division of Oncology Gianfranco Soldera Prostate Cancer Laboratory IRCCS San Raffaele Scientific Institute Milan Italy; Vita Salute San Raffaele University Milan Italy

University Hospital S Giovanni Battista Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino Turin Italy

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Metastasis-directed therapy in oligometastatic prostate cancer