Cytoreductive prostatectomy in metastatic prostate cancer: current knowledge and future directions

The current standard of care for patients with metastatic prostate cancer is systemic androgen deprivation therapy, and addressing the primary tumor has been reserved for patients with localized disease. However, emerging data has called into question the universality of this paradigm. Recent studies have found treatment of the primary tumor in patients with metastatic disease not only can provide the patient with symptomatic relief but also may provide a survival benefit. The potential biological and clinical benefit for cytoreductive surgery has been also been suggested in several translational models. Thus, PubMed electronic database was queried for publications on patients with metastatic prostate cancer who underwent cytoreductive prostatectomy, using keywords including: cytoreductive prostatectomy, radical prostatectomy, metastatic prostate cancer. In this review we examine literature regarding feasibility of cytoreductive prostatectomy, oncologic outcomes, and future directions including the ongoing clinical trials in this arena. While the retrospective data is encouraging, results of these ongoing prospective trials are needed before this option is offered to patients as a reasonably safe treatment with demonstrated benefits to survival and quality of life.