EURURO Vol. 72 No. 2

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patients might be associated with worse perioperative
outcomes compared with the nonmetastatic setting. This
might be related to disease aggressiveness and thus to the
need for more extensive local and nodal dissection. It should
also be highlighted that all patients included in the current
study were treated with open surgery; therefore, we were
not able to evaluate the potential perioperative benefits
associated with minimally invasive approaches in men with
oligometastatic PCa .
When considering oncologic outcomes, our cohort had
median follow-up of 63 mo, which represents the longest
available follow-up assessing the role of surgery in this
context. Of note, RP with extended nodal dissection
administered in a multimodal setting was associated with
acceptable long-term results in which only one of two
patients experienced clinical recurrence and one of five had
died from PCa at 7-yr follow-up. We should highlight that
virtually all patients treated in our cohort received ADT
before and/or after surgery and that the majority received
postoperative radiotherapy. Consequently, RP could poten-
tially represent an option only when considered in a
multimodal setting. Unfortunately, the lack of a control
group of oligometastatic patients not receiving local
treatment prevented us from comprehensively assessing
the oncologic benefit associated with RP. Nevertheless, the
long-term disease-free survival observed in our study was
higher than that observed in men managed with ADT alone,
for whom the 5-yr CSM-free survival rates ranged between
48% and 55% . [9_TD$DIFF]Randomized [10_TD$DIFF]controlled [11_TD$DIFF]trials [12_TD$DIFF]will [13_TD$DIFF]help
[14_TD$DIFF]clarify [15_TD$DIFF]the [16_TD$DIFF]role [17_TD$DIFF]of [18_TD$DIFF]local [19_TD$DIFF]treatment in[2_TD$DIFF] the [20_TD$DIFF]metastatic [21_TD$DIFF]scenario
[22_TD$DIFF] Moreover,[4_TD$DIFF] the [23_TD$DIFF]inclusion of a [24_TD$DIFF]small group [25_TD$DIFF]of [26_TD$DIFF]highly
[27_TD$DIFF]selected [28_TD$DIFF]patients [29_TD$DIFF]resulted [30_TD$DIFF]in [31_TD$DIFF]wide [32_TD$DIFF]confidence [33_TD$DIFF]intervals [34_TD$DIFF]and
[35_TD$DIFF]might [36_TD$DIFF]limit the [37_TD$DIFF]generalizability [38_TD$DIFF]of [39_TD$DIFF]our findings.
In conclusion, we reported perioperative and long-term
oncologic outcomes of RP in a highly selected cohort of
patients with bone metastases. Our findings support the
safety of RP in this setting.
Author contributions: Alberto Briganti had full access to all the data in
the study and takes responsibility for the integrity of the data and the
accuracy of the data analysis.
Study concept and design: Briganti, Rigatti, Montorsi.
Acquisition of data: Stabile, Bandini.
Analysis and interpretation of data: Gandaglia, Briganti, Montorsi.
Drafting of the manuscript: Gandaglia, Briganti, Montorsi.
Critical revision of the manuscript for important intellectual content:
Briganti, Montorsi.
Statistical analysis: Gandaglia, Fossati.
Obtaining funding: None.
Administrative, technical, or material support: None.
Supervision: Montorsi, Briganti.
Other (specify): None.
Financial disclosures: Alberto Briganti certifies that all conflicts of
interest, including specific financial interests and relationships and
affiliations relevant to the subject matter or materials discussed in the
manuscript (eg, employment/ affiliation, grants or funding, consultan-
cies, honoraria, stock ownership or options, expert testimony, royalties,
or patents filed, received, or pending), are the following: None.
Funding/Support and role of the sponsor: None.
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