{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T11:01:14Z","timestamp":1791198074686,"version":"4.1.0"},"reference-count":89,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Oligometastatic prostate cancer (OMPC) comprises biologically and clinically distinct states with a limited number of detectable metastases. Improved systemic therapy and prostate-specific membrane antigen positron emission tomography\/computed tomography (PSMA PET\/CT) have intensified interest in treating the primary tumor. Methods: In this narrative review we searched PubMed\/MEDLINE from inception to 1 July 2026, reviewed current guidelines, and searched ClinicalTrials.gov, the ISRCTN registry and the EU Clinical Trials Register for ongoing surgical studies, prioritizing randomized trials, prospective studies, PSMA PET-staged cohorts, systematic reviews, guidelines, and studies of perioperative, functional and patient-reported outcomes. Results: Registry and institutional data generated the hypothesis that cytoreductive prostatectomy improves outcomes but are vulnerable to selection bias; prospective and PSMA PET-staged cohorts established feasibility. The phase II trial by Dai and colleagues supported radical treatment of the primary tumor but combined surgery and radiotherapy. RAMPP provided the first prostatectomy-specific randomized signal, with lower 5-year cancer-specific mortality after radical prostatectomy plus best systemic therapy than after systemic therapy alone (13% versus 23%; hazard ratio 0.39, 95% confidence interval 0.16\u20130.98), but accrual ended early, clinical progression was similar, overall survival was not significantly improved, systemic therapy predated contemporary intensification, and major surgery-related complications occurred in 14%. A randomized phase II trial with a predominantly surgical local-therapy arm found no progression-free or overall survival benefit, so randomized evidence is mixed. All randomized evidence concerns radical prostatectomy or local treatment irrespective of surgical approach; no trial has tested a robot-specific oncologic effect. Guidelines recommend prostate radiotherapy for selected low-volume de novo metastatic disease and restrict surgery to clinical trials. Conclusions: Cytoreductive prostatectomy, delivered mostly as robot-assisted radical prostatectomy (RARP), is feasible and may improve local control while providing complete pathology, but it remains investigational; the robotic approach is the surgical platform, not a modality with distinct oncologic efficacy. Appropriate use requires expert-center surgery, modern staging, guideline-concordant systemic therapy, multidisciplinary selection, transparent counseling and, preferably, trial participation. Future trials must establish whether prostatectomy adds meaningful benefit beyond modern systemic therapy, prostate radiotherapy and metastasis-directed treatment, while measuring morbidity, continence and quality of life.<\/jats:p>","DOI":"10.3390\/cancers18193207","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T10:02:27Z","timestamp":1791194547000},"page":"3207","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cytoreductive Radical Prostatectomy in Oligometastatic Prostate Cancer and the Role of the Robotic Platform: A Narrative Review"],"prefix":"10.3390","volume":"18","author":[{"given":"Juan Gomez","family":"Rivas","sequence":"first","affiliation":[{"name":"Department of Urology, Hospital Cl\u00ednico San Carlos, Instituto de Investigaci\u00f3n Sanitaria del Hospital Cl\u00ednico San Carlos (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro Gabriel","family":"Silva","sequence":"additional","affiliation":[{"name":"Department of Urology, Unidade Local de Sa\u00fade de S\u00e3o Jos\u00e9, 1150-199 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena Margot Fl\u00f4res Soares da","family":"Silva","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu\u00eds","family":"Severo","sequence":"additional","affiliation":[{"name":"Department of Urology, Unidade Local de Sa\u00fade de S\u00e3o Jos\u00e9, 1150-199 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu\u00eds Campos","family":"Pinheiro","sequence":"additional","affiliation":[{"name":"Department of Urology, Unidade Local de Sa\u00fade de S\u00e3o Jos\u00e9, 1150-199 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2223-9018","authenticated-orcid":false,"given":"Isabel Galante","family":"Romo","sequence":"additional","affiliation":[{"name":"Department of Urology, Hospital Cl\u00ednico San Carlos, Instituto de Investigaci\u00f3n Sanitaria del Hospital Cl\u00ednico San Carlos (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrique","family":"Redondo-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Department of Urology, Hospital Cl\u00ednico San Carlos, Instituto de Investigaci\u00f3n Sanitaria del Hospital Cl\u00ednico San Carlos (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Gonz\u00e1lez-Santander","sequence":"additional","affiliation":[{"name":"Department of Urology, Hospital Cl\u00ednico San Carlos, Instituto de Investigaci\u00f3n Sanitaria del Hospital Cl\u00ednico San Carlos (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6837-7718","authenticated-orcid":false,"given":"Jes\u00fas Moreno","family":"Sierra","sequence":"additional","affiliation":[{"name":"Department of Urology, Hospital Cl\u00ednico San Carlos, Instituto de Investigaci\u00f3n Sanitaria del Hospital Cl\u00ednico San Carlos (IdISSC), Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,10,4]]},"reference":[{"key":"ref_1","unstructured":"G\u00f3mez Rivas, J., Fern\u00e1ndez Hern\u00e1ndez, L., Puente V\u00e1zquez, J., Vidal Casinello, N., Galante Romo, M.I., Redondo Gonz\u00e1lez, E., Senovilla P\u00e9rez, J.L., Abad L\u00f3pez, P., Sanmamed Salgado, N., and Vives Dilme, R. 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