title: The oncologic role of local treatment in primary metastatic prostate cancer.
abstract: OBJECTIVE
  To determine the oncologic benefit or otherwise of local treatment of the prostate in patients with primary metastatic prostate cancer.
  
  
  METHODS
  A review of the literature was performed in April 2014 using the Medline/PubMed database. Studies were identified using the search terms "prostate cancer," "metastatic," "metastasis," "high risk," "radiation therapy," "radiotherapy" and "prostatectomy" from 1990 until April, 2014. Articles were also identified through searches of references of these articles.
  
  
  RESULTS
  Retrospective series and population-based data suggest that the use of local treatment of the prostate in patients with primary metastatic prostate cancer may improve cancer-specific survival and overall survival compared with treating these patients with androgen deprivation therapy alone. The clinical outcome in metastatic prostate cancer is largely determined by the extent of lymph node involvement and overall metastatic burden. Contemporary data are lacking to recommend one alternative of local therapy (radiotherapy or radical prostatectomy) over the other. The primary limitation of this literature review is the lack of published randomized trial assessing the role of local treatment in addition to systemic therapy.
  
  
  CONCLUSIONS
  Local treatment appears to improve oncologic outcomes in metastatic prostate cancer patients. Nevertheless, due to the lack of high-quality evidence, its role needs to be confirmed in future prospective trials. The selection of ideal candidates and optimal treatment alternative (radiotherapy, radical prostatectomy or other) warrants further investigation.
authors.affiliation: Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Pirus
authors.initials: P
authors.lastname: Ghadjar
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.forename: Peter J L
authors.initials: PJ
authors.lastname: De Visschere
authors.forename: Jurgen J
authors.initials: JJ
authors.lastname: Fütterer
authors.forename: Gianluca
authors.initials: G
authors.lastname: Giannarini
authors.forename: Hendrik
authors.initials: H
authors.lastname: Isbarn
authors.forename: Piet
authors.initials: P
authors.lastname: Ost
authors.forename: Prasanna
authors.initials: P
authors.lastname: Sooriakumaran
authors.forename: Christian I
authors.initials: CI
authors.lastname: Surcel
authors.forename: Roderick C N
authors.initials: RC
authors.lastname: van den Bergh
authors.forename: Inge M
authors.initials: IM
authors.lastname: van Oort
authors.forename: Ofer
authors.initials: O
authors.lastname: Yossepowitch
authors.forename: Guillaume
authors.initials: G
authors.lastname: Ploussard
mesh_terms: D000726:Androgen Antagonists / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000556:secondary*; D017024:Chemotherapy, Adjuvant; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D009362:Neoplasm Metastasis; D010388:Pelvis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology / Q000628:therapy*; D018714:Radiotherapy, Adjuvant / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists