Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

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

Prostate Cancer and Prostatic Diseases (2023)Cite this article

Subjects

Abstract

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.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1

Similar content being viewed by others

References

  1. Stevens DJ, Sooriakumaran P. Oligometastatic prostate cancer. Curr Treat Options Oncol. 2016;17:62.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Reyes DK, Pienta KJ. The biology and treatment of oligometastatic cancer. Oncotarget. 2015;6:8491–524.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Boevé LMS, Hulshof MCCM, Vis AN, Zwinderman AH, Twisk JWR, Witjes WPJ, et al. Effect on survival of androgen deprivation therapy alone compared to androgen deprivation therapy combined with concurrent radiation therapy to the prostate in patients with primary bone metastatic prostate cancer in a prospective randomised clinical trial: data from the HORRAD trial. Eur Urol. 2019;75:410–8.

    Article  PubMed  Google Scholar 

  4. Parker CC, James ND, Brawley CD, Clarke NW, Hoyle AP, Ali A, et al. Systemic Therapy for Advanced or Metastatic Prostate cancer: Evaluation of Drug Efficacy (STAMPEDE) investigators. Radiotherapy to the primary tumour for newly diagnosed, metastatic prostate cancer (STAMPEDE): a randomised controlled phase 3 trials. Lancet. 2018;392:2353–66.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Cornford P, van den Bergh RCN, Mottet N. EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer. Part II-2020 Update: Treatment of Relapsing and Metastatic Prostate Cancer. Eur Urol. 2021;79:263–82.

  6. Solberg A, Haugen OA, Viset T, Bergh A, Tasdemir I, Ahlgren G, et al. Residual prostate cancer in patients treated with endocrine therapy with or without radical radiotherapy: a side study of the SPCG-7 randomized trial. Int J Radiat Oncol Biol Phys. 2011;80:55–61.

    Article  PubMed  Google Scholar 

  7. Tzelepi V, Efstathiou E, Wen S, et al. Persistent, biologically meaningful prostate cancer after 1 year of androgen ablation and docetaxel treatment. J Clin Oncol. 2011;29:2574–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Knoll T, Omar MI, Maclennan S, et al. Key steps in conducting systematic reviews for underpinning clinical practice guidelines: methodology of the European Association of urology. Eur Urol. 2018;73:290–300.

    Article  PubMed  Google Scholar 

  9. Moga C, Guo B, Schopflocher DP, Harstall C. Development of a quality appraisal tool for case series. Stud Using a Modif Delphi Tech (2012).

  10. Heidenreich A, Pfister D, Porres D. Cytoreductive radical prostatectomy in patients with prostate cancer and low volume skeletal metastases: results of a feasibility and case-control study. J Urol. 2015;193:832–8.

    Article  PubMed  Google Scholar 

  11. Gandaglia G, Fossati N, Stabile A, Bandini M, Rigatti P, Montorsi F, et al. Radical prostatectomy in men with oligometastatic prostate cancer: results of a single-institution series with long-term follow-up. Eur Urol. 2017;72:289–92.

    Article  PubMed  Google Scholar 

  12. Sooriakumaran P, Karnes J, Stief C, Copsey B, Montorsi F, Hammerer P, et al. A multi-institutional analysis of perioperative outcomes in 106 men who underwent radical prostatectomy for distant metastatic prostate cancer at presentation. Eur Urol. 2016;69:788–94.

    Article  PubMed  Google Scholar 

  13. Steuber T, Berg KD, Røder MA, Brasso K, Iversen P, Huland H, et al. Does cytoreductive prostatectomy really have an impact on prognosis in prostate cancer patients with low-volume bone metastasis? Results from a prospective case-control study. Eur Urol Focus. 2017;3:646–9.

    Article  PubMed  Google Scholar 

  14. Poelaert F, Verbaeys C, Rappe B, Kimpe B, Billiet I, Plancke H, et al. Cytoreductive prostatectomy for metastatic prostate cancer: first lessons learned from the multicentric prospective LoMP trial. Urology. 2017;106:146–52.

    Article  PubMed  Google Scholar 

  15. O’Shaughnessy MJ, McBride SM, Vargas HA, Touijer KA, Morris MJ, Danila DC, et al. A pilot study of a multimodal treatment paradigm to accelerate drug evaluations in early-stage metastatic prostate cancer. Urology. 2017;102:164–72.

    Article  PubMed  Google Scholar 

  16. Jang WS, Kim MS, Jeong WS, Chang KD, Cho KS, Ham WS, et al. Does robot-assisted radical prostatectomy benefit prostate cancer patients with bone oligometastases? BJU Int. 2018;121:225–31.

    Article  PubMed  Google Scholar 

  17. Heidenreich A, Fossati N, Pfister D, Suardi N, Montorsi F, Shariat S, et al. Cytoreductive radical prostatectomy in men with prostate cancer and skeletal metastases. Eur Urol Oncol. 2018;1:46–53.

    Article  PubMed  Google Scholar 

  18. S Knipper, B Beyer, P Mandel, P Tennstedt, D Tilki, T Steuber et al. Outcome of patients with newly diagnosed prostate cancer with low metastatic burden treated with radical prostatectomy: a comparison to STAMPEDE arm H. World J Urol. 2020;38:1459–64.

  19. Lan T, Chen Y, Su QJ, Ye JJ. Oncological outcome of cytoreductive radical prostatectomy in prostate cancer patients with bone oligometastases. Urology. 2019;131:166–75.

    Article  PubMed  Google Scholar 

  20. Si S, Zheng B, Wang Z, Niu Z. Does surgery benefit patients with oligometastatic or metastatic prostate cancer? - A retrospective cohort study and meta-analysis. Prostate. 2021;81:736–44.

    Article  CAS  PubMed  Google Scholar 

  21. Hellman SWR. Oligometastases. J Clin Oncol. 1995;13:8–10.

    Article  CAS  PubMed  Google Scholar 

  22. Lecouvet FE, Oprea-Lager DE, Liu Y, Ost P, Bidaut L, Collette L, et al. Use of modern imaging methods to facilitate trials of metastasis-directed therapy for oligometastatic disease in prostate cancer: a consensus recommendation from the EORTC Imaging Group. Lancet Oncol. 2018;19:e534–e545.

    Article  PubMed  Google Scholar 

  23. Wuttig D, Baier B, Fuessel S, et al. Gene signatures of pulmonary metastases of renal cell carcinoma reflect the disease-free interval and the number of metastases per patient. Int J Cancer. 2009;125:474–82.

    Article  CAS  PubMed  Google Scholar 

  24. Tosoian JJ, Gorin MA, Ross AE, Pienta KJ, Tran PT, Schaeffer EM. Oligometastatic prostate cancer: definitions, clinical outcomes, and treatment considerations. Nat Rev Urol. 2017;14:15–25.

    Article  CAS  PubMed  Google Scholar 

  25. Liu Y, Dong Y, Kong L, Shi F, Zhu H, Yu J. Abscopal effect of radiotherapy combined with immune checkpoint inhibitors. J Hematol Oncol. 2018;11:104.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Abrahamsson PA. Potential benefits of intermittent androgen suppression therapy in the treatment of prostate cancer: a systematic review of the literature. Eur Urol. 2010;57:49–59.

    Article  CAS  PubMed  Google Scholar 

  27. Heidenreich A, et al. EAU guidelines on prostate cancer. Part II: treatment of advanced, relapsing, and castration-resistant prostate cancer. Eur Urol. 2014;65:467–79.

    Article  CAS  PubMed  Google Scholar 

  28. Culp SH, Schellhammer PF, Williams MB. Might men diagnosed with metastatic prostate cancer benefit from definitive treatment of the primary tumour? A SEER-based study. Eur Urol. 2014;65:1058–66.

    Article  PubMed  Google Scholar 

  29. Gratzke C, Engel J, Stief CG. Role of radical prostatectomy in clinically non-organ-confined prostate cancer. Curr Urol Rep. 2014;15:455.

    Article  PubMed  Google Scholar 

  30. Comen E, Norton L, Massague J. Clinical implications of cancer self-seeding. Nat Rev Clin Oncol. 2011;8:369–77.

    Article  PubMed  Google Scholar 

  31. Bayne CE, Williams SB, Cooperberg MR, et al. Treatment of the primary tumor in metastatic prostate cancer: current concepts and future perspectives. Eur Urol. 2016;69:775–87.

    Article  PubMed  Google Scholar 

  32. Koo KC, Dasgupta P. Treatment of oligometastatic hormone-sensitive prostate cancer: a comprehensive review. Yonsei Med J. 2018;59:567–79.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Moris L, Cumberbatch MG, Van den Broeck T, Gandaglia G, Fossati N, Kelly B, et al. Benefits and risks of primary treatments for high-risk localized and locally advanced prostate cancer: an international multidisciplinary systematic review. Eur Urol. 2020;77:614–27.

    Article  CAS  PubMed  Google Scholar 

  34. Kleinclauss F, Thiery-Vuillemin A. Prise en charge du cancer de la prostate oligo-métastatique. Progrès en urologie. 2019;29:S20–S34.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of urology, CHU Souss Massa, Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco

    A. Saouli, H. Dergamoun & I. Ziouziou

  2. Casablanca Urology Center, Casablanca, Morocco

    A. Touzani & A. Ouzzane

  3. Oasis Urology Center, Casablanca International Oncology Center, Casablanca, Morocco

    A. Touzani & A. Ouzzane

  4. Department of Urology, La Croix du Sud Hospital, Quint-Fonsegrives, France

    A. Touzani, A. Martini, J. B. Beauval & G. Ploussard

  5. IUCT-O, Toulouse, France

    A. Touzani, A. Martini, J. B. Beauval & G. Ploussard

  6. Department of Urology, M.D. Anderson Cancer Center, Houston, TX, USA

    A. Martini

  7. Institut d’Urologie d’Auxerre, Polyclinique Sainte-Marguerite, Auxerre, France

    N. Deffar & A. Ouzzane

  8. Institut de Cancérologie de Bourgogne, Dijon, France

    N. Deffar & A. Ouzzane

Authors
  1. A. Saouli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Touzani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Martini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. B. Beauval
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H. Dergamoun
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. I. Ziouziou
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. N. Deffar
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. G. Ploussard
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. A. Ouzzane
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AS, AO: protocol/project development. AS, AO, AT: data collection or management. AS, AT, HD, AM, JBB, IZ, ND, GP, AO: data analysis.

Corresponding author

Correspondence to A. Saouli.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Saouli, A., Touzani, A., Martini, A. et al. Is there a role for radical prostatectomy in the management of oligometastatic prostate cancer? A systematic review. Prostate Cancer Prostatic Dis (2023). https://doi.org/10.1038/s41391-023-00752-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41391-023-00752-5

This article is cited by

Search

Advanced search

Quick links