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Page 4 of 8 Wagaskar et al. Mini-invasive Surg 2022;6:14 https://dx.doi.org/10.20517/2574-1225.2021.106

DATA-EXTRACTION
Table 1 shows the summary of included studies that were finalized after evidence acquisition and search
strategy. It involves sample size, study design, the definition of OMPC, and the selected approach - CRP,
PFS, CCS, and OS [Table 1].

RESULTS
Our search identified 524 records. After excluding duplication, 54 full-text articles were identified and were
screened for eligibility. We found nine papers (863 patients) that met the inclusion criteria for the review.
Four studies were retrospective; four were population-based. One study was prospective.

[7]
Heidenreich et al. assessed 113 patients with osseous MPC who underwent CRP. The results showed 80%
5-year OS, 9% risk of surgery-related complications, and 68% urinary continence at 12 months after CRP.
Sooriakumaran et al. retrospectively assessed 106 patients with MPC who underwent CRP with extended
[11]
lymphadenectomy. They reported 89% OS at 23 months, 64% urinary continence at 3 months, and 14%
surgery-related complications. Jang et al. retrospectively reviewed records of 79 men with OMPC, 38 of
[12]
whom underwent robot-assisted CRP. They found 75% PFS in patients with RA-CRP vs. 40% PFS in men
without RA-CRP at 40 months. Additionally, 5% of men experienced surgery-related complications in the
[13]
RA-CRP group. Culp et al. used a population-based SEER database of 8185 men with MPC of whom 245
underwent CRP. They reported CSS of 76% in CRP vs. 61% with non-CRP men at 5 years. The authors also
[14]
noted OS at 5 years at 67% in the CRP group vs. 53% in the non-CRP group. Gandaglia et al. analyzed
perioperative and long-term (7 years) oncologic outcomes of radical prostatectomy in a selected cohort of
11 patients with OMPC treated with RP and extended pelvic lymph node dissection. PFS was 45% and CSM
[15]
was 82% with 18% of grade 3 post-operative complications. Satkunasivam et al. assessed survival following
local therapy in comparison with no local therapy for 4069 men with metastatic prostate cancer from the
SEER-Medicare linked database. RP compared to NLT was associated with a 52% reduction in the risk of
prostate cancer-specific mortality (HR = 0.48, 95%CI: 0.27-0.85). OS at 3 years was 73% for RP.
[16]
Gratzke et al. reported the results of 1538 patients from the Munich Cancer Registry with newly
diagnosed MPCa. Of these, 1464 patients (95%) without surgery (RP-) vs. 74 patients (5%) underwent
RP+ . Patients in the RP+ group showed a 55% 5-year OS rate compared with 21% in the RP- group (P <
[16]
0.01). Antwi et al. evaluated 7858 patients obtained from the SEER program who underwent RP or BT. In
[17]
the RP group, they found a 73% (HR = 0.27, 95%CI: 0.20-0.38) lower risk of all-cause mortality and 72% (HR
[17]
= 0.28, 95%CI: 0.20-0.39) reduced risk of death from prostate cancer . Poelaert et al. prospectively
[18]
compared early results of 36 patients with cytoreductive radical prostatectomy (17) vs. no local treatment
(29). RP group patients were younger (64 years vs. 72 years, P = 0.005), had lower initial prostate-specific
antigen (15.9 g/L vs. 156 g/L, P = 0.002), and less high-volume metastatic disease (5.9% vs. 69%, P < 0.001).
At 3 months 2 (6.8%), 11 (37.9%), and 2 (6.8%), patients suffered urge incontinence, obstructive voiding
needing medical intervention, and ureteric obstruction, and 5 (29.4%) and 2 (11.8%) patients suffered grades
1 and 2 post-operative complications .
[18]

DISCUSSION
Robot-assisted radical prostatectomy (RARP) is the most common form of treatment in men with organ-
confined prostate cancer . RARP has shown promising results in locally advanced prostate cancer
[19]
treatment . Here we reviewed 9 papers (4 retrospective, 4 population-based and 1 prospective) for
[20]
oncological and functional outcomes of cytoreductive radical prostatectomy (open or robot-assisted) in
OMPC settings. We identified 3 key themes: (1) improved overall survival statistics (PFS, OS, CSS) are seen
after CRP for men with OMPC compared to men without CRP; (2) CPR is shown to be feasible and safe
(fewer surgery-related complication rates with acceptable functional outcomes) with cytoreductive