传统上，单纯根治性前列腺切除术（RP）对于高危局限性前列腺癌（HRPC）患者来说被认为是不够的，因为手术后经常需要辅助挽救性放疗或雄激素剥夺疗法（ADT）。此前，全身治疗（例如 ADT）是转移性前列腺癌（PC）患者的标准治疗方法； RP 被认为对这些患者不可行。然而，自2015年以来，人们认识到可以根据转移程度对转移性PC患者进行分类，从而导致某些转移性病例考虑进行RP。近年来，细胞减灭术的概念受到关注。研究表明，它可以通过肿瘤减灭和增强免疫反应等机制提高转移性​​ PC 患者的生存率。一项回顾性研究的荟萃分析表明，与单独的全身治疗相比，细胞减灭术 RP 与 1 年、3 年和 5 年间隔的癌症特异性生存率较高相关。在我们的研究中，对 HRPC 和寡转移性 PC 患者进行平均 46 个月的随访，观察到 17.8% 的 HRPC 和 13% 的寡转移性患者出现生化复发，总生存率分别为 96.4% 和 87%。尽管仍缺乏前瞻性或随机研究，但当前的回顾性研究（包括我们自己的研究）表明 RP 在 HRPC 和寡转移患者中具有良好的结果。随着机器人手术的日益普及、盆腔解剖学观察的改进以及手术信心的增强，前瞻性随机研究结果的实现可能并不遥远。© 2024。外科肿瘤学会。

Radical prostatectomy (RP) alone has traditionally been considered insufficient for patients with high-risk localized prostate cancer (HRPC) owing to the frequent need for adjuvant salvage radiotherapy or androgen deprivation therapy (ADT) following surgery. Previously, systemic therapy, such as ADT, was the standard treatment for metastatic prostate cancer (PC) patients; RP was not considered viable for these patients. However, since 2015, there has been a recognition that metastatic PC patients can be categorized based on the extent of their metastases, leading to the consideration of RP for some metastatic cases. In recent years, the concept of cytoreductive RP has gained traction; studies suggest that it may improve survival rates in metastatic PC patients through mechanisms, such as tumor debulking and enhancement of the immune response. A meta-analysis of retrospective studies has shown that cytoreductive RP is associated with higher cancer-specific survival rates at 1-year, 3-year, and 5-year intervals compared with systemic therapy alone. In our study, which followed HRPC and oligometastatic PC patients for an average of 46 months, we observed biochemical recurrence in 17.8% of HRPC and 13% of oligometastatic patients, with overall survival rates of 96.4% and 87%, respectively. Although prospective or randomized studies are still lacking, current retrospective studies, including our own, suggest promising outcomes for RP in HRPC and oligometastatic patients. With the increasing prevalence of robotic surgery, improved pelvic anatomy observation, and growing surgical confidence, the realization of prospective randomized study results may not be far off.© 2024. Society of Surgical Oncology.