The Expanding Role of the Urologist in Metastatic Prostate Cancer: From Biopsy to Surgical Interventions

The evolving landscape of metastatic prostate cancer (mPCa) necessitates a redefinition of the urologist's role, extending beyond diagnosis to active participation in therapeutic and surgical management. This review outlines evidence-based approaches to biopsy and surgical interventions across the disease spectrum. Prostate biopsy remains fundamental for diagnosis, treatment stratification, and molecular profiling, with targeted and metastatic lesion sampling improving precision oncology. For symptom relief, surgical management of bladder outlet obstruction through transurethral resection of the prostate and holmium laser enucleation of the prostate remains essential, with emerging data suggesting possible oncologic benefits when combined with systemic therapy. GreenLight photoselective vaporization may represent an alternative option, though evidence remains limited. Cytoreductive radical prostatectomy in carefully selected patients with metastatic hormone-sensitive disease may provide improved local control and delayed progression, supported by growing biological rationale but constrained by the retrospective nature of current evidence. Collectively, these findings underscore the expanding multidisciplinary role of the urologist in mPCa care, emphasizing the need for prospective studies to validate the integration of surgical approaches within systemic treatment frameworks.