52 A new multicentre European study has revealed that cytoreductive radical prostatectomy (cRP) can offer promising outcomes for men with oligometastatic prostate cancer (omPCa), particularly when detected using advanced prostate-specific membrane antigen (PSMA) positron emission tomography (PET) imaging. The research highlights the feasibility of surgery in cases traditionally considered beyond the scope of local treatment. The findings were published in the journal European Urology Oncology. The study examined 116 patients across 13 leading European centres who underwent surgery for prostate cancer with limited metastases—defined as five or fewer bone lesions or up to three lung nodules. PSMA-PET, a highly sensitive molecular imaging technique, allowed for early detection of these cases, which might have been missed with conventional imaging methods. The findings demonstrated favourable short-term survival rates. At two years, castration-resistant prostate cancer-free survival stood at 85.8%, while overall survival was nearly 99%. These results suggest that local surgery, combined with systemic therapies such as androgen deprivation treatment (ADT), may delay disease progression and improve patient outcomes. The safety of cRP was also assessed, showing that complications were manageable, with only 5% of patients experiencing major issues requiring further intervention. At the one-year mark, over 80% of patients maintained urinary continence, underscoring the functional viability of the procedure when performed in high-expertise centres. However, the research identified some challenges. Despite the favourable outcomes, a subset of patients exhibited a risk of early disease progression. Notably, those with lymph node involvement (miN1) had poorer prognosis compared to those without. This highlights the need for a multimodal approach, incorporating surgery, systemic therapy, and metastasis-directed treatments to address the disease comprehensively. The study also sheds light on variability in treatment approaches across centres, reflecting the lack of standardised guidelines for omPCa management. While radiation therapy and systemic treatments remain the recognised standards for metastatic prostate cancer, the role of surgery in the oligometastatic setting remains under investigation. The results from this research provide an essential foundation for future studies exploring the combination of cRP with novel therapies. The increasing use of PSMA-PET has led to a “stage migration”, allowing clinicians to identify metastatic disease earlier than ever before. This shift may help tailor treatments more effectively, offering patients with limited metastases an opportunity for more aggressive interventions that could prolong survival. The findings underscore the importance of multidisciplinary treatment strategies in oligometastatic prostate cancer. As treatment options continue to evolve, further long-term studies are needed to confirm the benefits of cytoreductive surgery and refine patient selection criteria. For now, cRP presents itself as a promising option for carefully selected patients, particularly when managed in specialised centres.