Role of cytoreductive prostatectomy in non-organ confined prostate cancer

Prostate cancer is the most common cancer among Australian men. Despite the surrounding controversies, prostate specific antigen screening has resulted in diagnosis being made at a stage in which the cancer is still confined to the prostate in the majority of cases. However, there is still a small subset of men who are not diagnosed until after the cancer has metastasised. Historically, these cases have been managed with androgen deprivation therapy with no role for surgery. However, with data supporting cytoreductive surgery in other cancers such as kidney, breast and ovarian, there is increasing interest in the role of surgery as part of a multimodal approach to men with metastatic prostate cancer. Early data suggest that surgery in this situation is feasible and safe, with encouraging data suggesting an oncological benefit. Randomised trials are underway to establish who might benefit and which strategy should be incorporated. In the meantime, radical prostatectomy in the context of metastatic disease should be considered experimental.