{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T14:08:28Z","timestamp":1791382108640,"version":"4.3.3"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T00:00:00Z","timestamp":1750982400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec014\">\n<jats:title>Background<\/jats:title>\n<jats:p>The role of radical prostatectomy (RP) in patients with newly diagnosed bone-metastatic prostate cancer (PCa) remains insufficiently explored.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec015\">\n<jats:title>Patients and methods<\/jats:title>\n<jats:p>Patients with newly diagnosed bone-metastatic PCa were retrospectively identified from the SEER-17 database and categorized into two groups based on local treatment: biopsy-only and RP. Notably, patients who had received radiotherapy were excluded due to the unavailability of radiotherapy target site details in the SEER database, which made it impossible to determine whether the radiotherapy was directed at metastatic lesions or the prostate. Kaplan-Meier methods were used to estimate cancer-specific survival (CSS) and overall survival (OS) between the two groups. Subgroup analyses stratified by T stage, N stage, PSA levels, and ISUP grade were conducted to assess the impact of disease characteristics on the efficacy of RP. A risk score incorporating these disease characteristics (T stage, N stage, PSA level, ISUP grade) was assigned to each patient, and risk-stratified subgroup analyses were performed to further evaluate the relationship between the efficacy of RP and overall disease characteristics.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec016\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 9,243 patients were included in this study, of whom 8,949 (96.8%) underwent biopsy alone and 294 (3.2%) underwent RP. Patients who underwent RP had better CSS (adjusted HR\u2009=\u20090.32, 95% CI: 0.23\u20130.44, p\u2009&lt;\u20090.001; 5-year CSS rate: 83.0% vs. 44.5%) and OS (adjusted HR\u2009=\u20090.34, 95% CI: 0.26\u20130.45, p\u2009&lt;\u20090.001; 5-year OS rate: 79.2% vs. 36.9%) compared with patients who underwent biopsy alone. The survival benefit persisted across all subgroups but were attenuated in patients with more advanced stage (T3 and N1) and higher grades of disease (PSA\u2009&gt;\u200972.5\u2009ng\/ml and ISUP grade IV-V). Risk score analysis revealed diminishing benefits with increasing scores. Significant survival benefits were observed for scores 0\u20133 (all adjusted HR\u2009&lt;\u20091, p\u2009&lt;\u20090.05), whereas no survival differences were detected at the highest risk score (CSS: adjusted HR\u2009=\u20091.74, 95% CI: 0.54\u20135.65, p\u2009=\u20090.356; OS: adjusted HR\u2009=\u20091.56, 95% CI: 0.48\u20135.04, p\u2009=\u20090.456).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec017\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Survival benefits of RP in de novo bone metastatic prostate cancer are modulated by disease characteristics, with attenuated effects in advanced\/high-grade disease. Risk-stratified patient selection is critical, and prospective studies are needed to validate optimal candidacy for RP.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0326429","type":"journal-article","created":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T17:32:13Z","timestamp":1751045533000},"page":"e0326429","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Survival benefit of radical prostatectomy in bone metastatic prostate cancer stratified by disease characteristics: A SEER-based retrospective analysis"],"prefix":"10.1371","volume":"20","author":[{"given":"Xinxing","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuxuan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,6,27]]},"reference":[{"issue":"3","key":"pone.0326429.ref001","doi-asserted-by":"crossref","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"F Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"issue":"1","key":"pone.0326429.ref002","doi-asserted-by":"crossref","first-page":"12","DOI":"10.3322\/caac.21820","article-title":"Cancer statistics, 2024","volume":"74","author":"RL Siegel","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"pone.0326429.ref003","article-title":"Prostate cancer incidence and mortality in Europe and implications for screening activities: population based study","volume":"386","author":"S Vaccarella","year":"2024","journal-title":"BMJ"},{"issue":"2","key":"pone.0326429.ref004","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.eururo.2024.03.027","article-title":"EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer-2024 Update. Part I: Screening, Diagnosis, and Local Treatment with Curative Intent","volume":"86","author":"P Cornford","year":"2024","journal-title":"Eur Urol"},{"issue":"1","key":"pone.0326429.ref005","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.prro.2023.09.007","article-title":"Radiation Therapy Summary of the AUA\/ASTRO Guideline on Clinically Localized Prostate Cancer","volume":"14","author":"Jr Deville C","year":"2024","journal-title":"Pract Radiat Oncol"},{"issue":"6","key":"pone.0326429.ref006","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1097\/JU.0000000000003452","article-title":"Updates to Advanced Prostate Cancer: AUA\/SUO Guideline (2023)","volume":"209","author":"W Lowrance","year":"2023","journal-title":"J Urol"},{"issue":"3","key":"pone.0326429.ref007","doi-asserted-by":"crossref","first-page":"140","DOI":"10.6004\/jnccn.2024.0019","article-title":"NCCN Guidelines\u00ae Insights: Prostate Cancer, Version 3.2024","volume":"22","author":"EM Schaeffer","year":"2024","journal-title":"J Natl Compr Canc Netw"},{"issue":"2","key":"pone.0326429.ref008","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.eururo.2024.04.010","article-title":"EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer. Part II-2024 Update: Treatment of Relapsing and Metastatic Prostate Cancer","volume":"86","author":"D Tilki","year":"2024","journal-title":"Eur Urol"},{"issue":"3","key":"pone.0326429.ref009","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1016\/j.eururo.2018.09.008","article-title":"Effect on Survival of Androgen Deprivation Therapy Alone Compared to Androgen Deprivation Therapy Combined with Concurrent Radiation Therapy to the Prostate in Patients with Primary Bone Metastatic Prostate Cancer in a Prospective Randomised Clinical Trial: Data from the HORRAD Trial","volume":"75","author":"LMS Boev\u00e9","year":"2019","journal-title":"Eur Urol"},{"issue":"10162","key":"pone.0326429.ref010","doi-asserted-by":"crossref","first-page":"2353","DOI":"10.1016\/S0140-6736(18)32486-3","article-title":"Radiotherapy to the primary tumour for newly diagnosed, metastatic prostate cancer (STAMPEDE): a randomised controlled phase 3 trial","volume":"392","author":"CC Parker","year":"2018","journal-title":"Lancet"},{"issue":"6","key":"pone.0326429.ref011","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003998","article-title":"Radiotherapy to the prostate for men with metastatic prostate cancer in the UK and Switzerland: Long-term results from the STAMPEDE randomised controlled trial","volume":"19","author":"CC Parker","year":"2022","journal-title":"PLoS Med"},{"issue":"8","key":"pone.0326429.ref012","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1056\/NEJMoa1503747","article-title":"Chemohormonal Therapy in Metastatic Hormone-Sensitive Prostate Cancer","volume":"373","author":"CJ Sweeney","year":"2015","journal-title":"N Engl J Med"},{"issue":"12","key":"pone.0326429.ref013","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1007\/s11864-016-0439-8","article-title":"Oligometastatic Prostate Cancer","volume":"17","author":"DJ Stevens","year":"2016","journal-title":"Curr Treat Options Oncol"},{"issue":"8","key":"pone.0326429.ref014","article-title":"Optimal primary surgical treatment for advanced epithelial ovarian cancer","volume":"2011","author":"A Elattar","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"issue":"23","key":"pone.0326429.ref015","doi-asserted-by":"crossref","first-page":"1655","DOI":"10.1056\/NEJMoa003013","article-title":"Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer","volume":"345","author":"RC Flanigan","year":"2001","journal-title":"N Engl J Med"},{"issue":"9286","key":"pone.0326429.ref016","doi-asserted-by":"crossref","first-page":"966","DOI":"10.1016\/S0140-6736(01)06103-7","article-title":"Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma: a randomised trial","volume":"358","author":"GH Mickisch","year":"2001","journal-title":"Lancet"},{"issue":"17","key":"pone.0326429.ref017","doi-asserted-by":"crossref","first-page":"3475","DOI":"10.1200\/JCO.2004.10.218","article-title":"Use of surgery among elderly patients with stage IV colorectal cancer","volume":"22","author":"LKF Temple","year":"2004","journal-title":"J Clin Oncol"},{"issue":"2","key":"pone.0326429.ref018","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.eururo.2017.06.002","article-title":"Management of Patients with Advanced Prostate Cancer: The Report of the Advanced Prostate Cancer Consensus Conference APCCC 2017","volume":"73","author":"S Gillessen","year":"2018","journal-title":"Eur Urol"},{"issue":"1","key":"pone.0326429.ref019","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.eururo.2019.02.003","article-title":"Prostate Radiotherapy for Metastatic Hormone-sensitive Prostate Cancer: A STOPCAP Systematic Review and Meta-analysis","volume":"76","author":"S Burdett","year":"2019","journal-title":"Eur Urol"},{"issue":"1","key":"pone.0326429.ref020","doi-asserted-by":"crossref","DOI":"10.1042\/BSR20171379","article-title":"The role of radical prostatectomy for the treatment of metastatic prostate cancer: a systematic review and meta-analysis","volume":"38","author":"Y Wang","year":"2018","journal-title":"Biosci Rep"},{"issue":"5","key":"pone.0326429.ref021","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1016\/j.euo.2022.06.001","article-title":"Combination of Androgen Deprivation Therapy with Radical Local Therapy Versus Androgen Deprivation Therapy Alone for Newly Diagnosed Oligometastatic Prostate Cancer: A Phase II Randomized Controlled Trial","volume":"5","author":"B Dai","year":"2022","journal-title":"Eur Urol Oncol"},{"issue":"6","key":"pone.0326429.ref022","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.1016\/j.eururo.2013.11.012","article-title":"Might men diagnosed with metastatic prostate cancer benefit from definitive treatment of the primary tumor? A SEER-based study","volume":"65","author":"SH Culp","year":"2014","journal-title":"Eur Urol"},{"issue":"3","key":"pone.0326429.ref023","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1016\/j.eururo.2014.04.009","article-title":"Role of radical prostatectomy in metastatic prostate cancer: data from the Munich Cancer Registry","volume":"66","author":"C Gratzke","year":"2014","journal-title":"Eur Urol"},{"issue":"1","key":"pone.0326429.ref024","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.eururo.2017.03.020","article-title":"Local Therapy Improves Survival in Metastatic Prostate Cancer","volume":"72","author":"S-R Leyh-Bannurah","year":"2017","journal-title":"Eur Urol"},{"issue":"2","key":"pone.0326429.ref025","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1016\/j.juro.2015.02.084","article-title":"Radical Prostatectomy or External Beam Radiation Therapy vs No Local Therapy for Survival Benefit in Metastatic Prostate Cancer: A SEER-Medicare Analysis","volume":"194","author":"R Satkunasivam","year":"2015","journal-title":"J Urol"},{"issue":"4","key":"pone.0326429.ref026","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1016\/j.eururo.2013.05.023","article-title":"Cancer-specific survival after metastasis following primary radical prostatectomy compared with radiation therapy in prostate cancer patients: results of a population-based, propensity score-matched analysis","volume":"65","author":"Y-HJ Shao","year":"2014","journal-title":"Eur Urol"},{"key":"pone.0326429.ref027","doi-asserted-by":"crossref","first-page":"1176935119835522","DOI":"10.1177\/1176935119835522","article-title":"Transcriptomics Signature from Next-Generation Sequencing Data Reveals New Transcriptomic Biomarkers Related to Prostate Cancer","volume":"18","author":"A Alkhateeb","year":"2019","journal-title":"Cancer Inform"},{"issue":"4","key":"pone.0326429.ref028","doi-asserted-by":"crossref","first-page":"219","DOI":"10.3390\/diagnostics9040219","article-title":"A Hierarchical Machine Learning Model to Discover Gleason Grade-Specific Biomarkers in Prostate Cancer","volume":"9","author":"O Hamzeh","year":"2019","journal-title":"Diagnostics (Basel)"},{"key":"pone.0326429.ref029","article-title":"Uncovering somatic genetic drivers in prostate cancer through comprehensive genome-wide analysis","author":"L Lin","year":"2025","journal-title":"Geroscience"},{"issue":"1","key":"pone.0326429.ref030","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1007\/s00345-024-04937-y","article-title":"Genetic susceptibility of urolithiasis: comprehensive results from genome-wide analysis","volume":"42","author":"L Lin","year":"2024","journal-title":"World J Urol"},{"issue":"1","key":"pone.0326429.ref031","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1038\/s42003-024-06114-8","article-title":"Investigating the causal associations between metabolic biomarkers and the risk of kidney cancer","volume":"7","author":"L Lin","year":"2024","journal-title":"Commun Biol"},{"issue":"3","key":"pone.0326429.ref032","article-title":"SGLT2 inhibition and three urological cancers: Up-to-date results","volume":"40","author":"L Lin","year":"2024","journal-title":"Diabetes Metab Res Rev"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0326429","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T17:32:19Z","timestamp":1751045539000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0326429"}},"subtitle":[],"editor":[{"given":"Yuki","family":"Arita","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,6,27]]},"references-count":32,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6,27]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0326429","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,27]]}}}