BACKGROUND: De novo oligometastatic prostate cancer (omPCa) on prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is a new disease entity and its optimal management remains unknown. OBJECTIVE: To analyze the outcomes of patients treated with cytoreductive radical prostatectomy (cRP) for omPCa on PSMA-PET. DESIGN, SETTING, AND PARTICIPANTS: Overall, 116 patients treated with cRP at 13 European centers were identified. Oligometastatic PCa was defined as miM1a and/or miM1b with five or fewer osseous metastases and/or miM1c with three or fewer lung lesions on PSMA-PET. INTERVENTION: Cytoreductive radical prostatectomy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Thirty-day complications according to Clavien-Dindo, continence rates, time to castration-resistant PCa (CRPC), and overall survival (OS) were analyzed. RESULTS AND LIMITATIONS: Overall, 95 (82%) patients had miM1b, 18 (16%) miM1a, and three (2.6%) miM1c omPCa. The median prebiopsy prostate-specific antigen was 14 ng/ml, and 102 (88%) men had biopsy grade group ≥3 PCa. The median number of metastases on PSMA-PET was 2; 38 (33%), 29 (25%), and 49 (42%) patients had one, two, and three or more distant positive lesions. A total of 70 (60%) men received neoadjuvant systemic therapy, and 37 (32%) underwent metastasis-directed therapy. Any and Clavien-Dindo grade ≥3 complications occurred in 36 (31%) and six (5%) patients, respectively. At a median follow-up of 27 mo, 19 (16%) patients developed CRPC and eight (7%) patients died. The 1-yr urinary continence rate was 82%. The 2-yr CRPC-free survival and OS were 85.8% (95% confidence interval [CI] 78.5-93.7%) and 98.9% (95% CI 96.8-100%), respectively. The limitations include retrospective design and short-term follow-up. CONCLUSIONS: Cytoreductive radical prostatectomy is a safe and feasible treatment option in patients with de novo omPCa on PSMA-PET. Despite overall favorable oncologic outcomes, some of these patients have a non-negligible risk of early progression and thus should be considered for multimodal therapy. PATIENT SUMMARY: We found that patients treated at expert centers with surgery for prostate cancer, with a limited number of metastases detected using novel molecular imaging, have favorable short-term survival, functional results, and acceptable rates of complications.

3rd Department of Radiotherapy and Chemotherapy Maria Sklodowska Curie National Research Institute of Oncology Gliwice Poland

Department of Biomedical Imaging and Image Guided Therapy Medical University of Vienna Vienna Austria

Department of Biostatistics and Bioinformatics Maria Sklodowska Curie National Research Institute of Oncology Gliwice Branch Gliwice Poland

Department of Radiation Oncology Comprehensive Cancer Center Medical University of Vienna Vienna Austria

Department of Radiotherapy Holy Cross Cancer Center Kielce Poland

Department of Surgery Candiolo Cancer Institute FPO IRCCS Candiolo Turin Italy

Department of Surgery Oncology and Gastroenterology University of Padua Padua Italy

Department of Urology Città della Salute e della Scienza University of Turin Turin Italy

Department of Urology Faculty of Medicine University Hospital Cologne University Cologne Cologne Germany

Department of Urology LMU Klinikum Ludwig Maximilians University Munich Munich Germany

Department of Urology Medical University of Vienna Vienna Austria

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

Department of Urology Medical University of Vienna Vienna Austria; Karl Landsteiner Institute of Urology and Andrology Vienna Austria; Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic; Division of Urology Hourani Center for Applied Scientific Research Al Ahliyya Amman University Amman Jordan; Department of Urology Weill Cornell Medical College New York NY USA; Department of Urology University of Texas Southwestern Dallas TX USA

Department of Urology Skåne University Hospital Lund University Malmö Sweden

Department of Urology St Antonius Hospital Utrecht The Netherlands

Department of Urology University Hospitals Leuven Leuven Belgium

Division of Nuclear Medicine IEO European Institute of Oncology IRCCS Milan Italy

Division of Urology Department of Oncology School of Medicine University of Turin San Luigi Hospital Orbassano Italy

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

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Metastasis-directed therapy in oligometastatic prostate cancer