Association of robot-assisted radical prostatectomy with improved oncological outcomes in patients with oligometastatic prostate cancer: A multicenter exploratory study in China.

OBJECTIVE: To evaluate the efficacy of robot-assisted radical prostatectomy (RARP) combined with androgen deprivation therapy (ADT) vs. ADT alone on oncological outcomes in oligometastatic prostate cancer (OmPCa) patients. METHODS: This multicenter retrospective analysis included 290 patients with OmPCa who received RARP combined with ADT (n = 170) or ADT alone (n = 120) at 5 Chinese medical centers between December 2008 and December 2023. Inverse probability of treatment weighting was applied to control for confounding factors. Radiographic progression-free survival (rPFS) and overall survival (OS) were used as clinical endpoints to evaluate the impact of RARP combined with ADT on oncological outcomes in patients with OmPCa. RESULTS: After IPTW adjustment, baseline characteristics were well balanced between the 2 groups (all SMD < 0.10). Compared with the non-surgical group, the surgical group had significantly prolonged median rPFS (hazard ratio = 0.24, 95% confidence interval: 0.17-0.33, P < 0.001) and median OS (hazard ratio = 0.22, 95% confidence interval: 0.14-0.33, P < 0.001). Time-varying covariate analysis also supported this finding (both P < 0.001). Exploratory subgroup analyses indicated that, regardless of baseline characteristics, patients in the surgical group had significantly prolonged rPFS and OS (all P < 0.05). CONCLUSION: RARP combined with ADT was significantly associated with improved oncological outcomes in patients with OmPCa, and this association was independent of baseline characteristics; however, this finding is limited by the relatively small sample size and requires validation in prospective studies.