LAUSR

Potential benefits of a definitive local treatment for the prostate itself in metastatic prostate cancer (mPCa) patients has been discussed recently [1]. Several reports showed that local treatment at the original prostate site could have a survival benefit for patients with this disease [2–4]. Locoregional therapy is not usually suggested for metastatic cancer in which tumor cells have already spread into systemic circulation and metastasis has developed; however, several studies focusing on other metastatic tumors demonstrated that a reduction in the primary tumor burden resulted in a survival benefit and a better response to systemic therapy. Among urogenital cancers, cytoreductive nephrectomy is a standard therapy for metastatic renal cell carcinoma because radical nephrectomy improves survival in patients treated with interferon for metastatic disease [5,6]. The current standard treatment for mPCa is androgen deprivation therapy (ADT); however, a definitive local treatment can be used when it reduces significant local symptoms, improves the response of systemic treatment, and leads to an overall survival (OS) benefit. A retrospective study from the Surveillance Epidemiology and End Results (SEER) database showed OS and cancer-specific survival (CSS) benefits when radical prostatectomy (RP) or brachytherapy was added to ADT in mPCa patients [2]. Data from the Munich cancer registry reproduced these results [3]. A small cohort study showed that cytoreductive prostatectomy for low-volume skeletal mPCa patients was feasible and associated with better outcome for both clinical progression-free survival (PFS) and CSS; however, these