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Oncologic Outcomes of Cytoreductive Radical Prostatectomy in Patients With Synchronous Metastatic
Kento Morozumi1, Kenji Numahata2, Masaaki Oikawa1
1Department of Urology, Tohoku Medical and Pharmaceutical University, Miyagi, Japan.
Cancer Medicine
|April 17, 2026
Summary
Cytoreductive radical prostatectomy (cRP) is a safe and feasible local treatment for metastatic castration-sensitive prostate cancer (mCSPC). Pathological treatment effect (pTE) after cRP strongly correlates with survival, offering critical insights not predictable preoperatively.
Area of Science:
- Urology
- Oncology
- Surgical Oncology
Background:
- Local therapy for metastatic castration-sensitive prostate cancer (mCSPC) is debated.
- Cytoreductive radical prostatectomy (cRP) is a potential treatment option.
Purpose of the Study:
- To evaluate the feasibility, safety, and oncologic outcomes of cRP in mCSPC patients.
- To analyze pathological findings and their correlation with survival.
Main Methods:
- Retrospective analysis of 61 mCSPC patients undergoing cRP after neoadjuvant androgen deprivation therapy (ADT).
- Assessment of clinical, perioperative, and pathological parameters.
- Survival analysis based on biopsy Gleason grade (GG), metastatic burden, PSA dynamics, and pathological treatment effect (pTE).
Main Results:
- Five-year cancer-specific survival (CSS) was 77.0%.
- Biopsy GG 5 correlated with adverse outcomes; pTE grade ≥2 was linked to favorable outcomes and improved CSS.
- Major perioperative complications (Clavien-Dindo ≥3) occurred in 1.6% of patients.
Conclusions:
- cRP is a feasible and safe local treatment for selected mCSPC patients.
- Pathological treatment effect (pTE) from cRP provides crucial prognostic information.
- cRP should be considered in multimodal treatment strategies for mCSPC.
