1. Abstract: Despite the availability of a number of new drugs, OS in patients with metastatic prostate cancer has not been substantially and significantly prolonged over the past two decades. In recent years, surgical treatment of patients with metastatic prostate cancer at the primary site has received increasing attention, and several retrospective studies have shown that reduced radical prostatectomy performed by highly qualified surgeons in carefully screened patients significantly prolongs OS and PFS. 2. Background of the Study Despite important advances in endocrine therapy, chemotherapy, and immunotherapy for metastatic prostate cancer Despite important advances in endocrine therapy, chemotherapy, and immunotherapy for metastatic prostate cancer, the 5-year overall survival rate for metastatic prostate cancer has not improved significantly over the past 20 years. Statistics show that the five-year overall survival rate for advanced metastatic prostate cancer is only about 30 percent. Studies from renal cell carcinoma have shown that in patients with metastatic kidney cancer, subtractive radical nephrectomy combined with interferon therapy improved 1-year survival by 13% compared to interferon therapy alone; and studies from ovarian cancer have shown that patients with ovarian cancer who had more than 75% of their tumor tissue removed by subtractive surgery extended their median Survival time was 11 months. These studies suggest that patients with certain metastatic cancers may also benefit from reduced tumor surgery at the primary site. In fact, a number of patients with metastatic prostate cancer have also undergone radical resection of the primary site in countries such as Europe and the United States. Therefore, the safety of radical prostatectomy in patients with metastatic prostate cancer needs to be evaluated. In this study, data from 106 patients with metastatic prostate cancer who underwent radical prostatectomy from 2007 to 2014 at 6 medical centers in the United States, Germany, Italy, and Sweden were retrospectively analyzed. 3. Results <1>The surgical procedure was radical prostatectomy + expanded pelvic lymph node dissection, including 97 open surgeries and 9 robotic surgeries. <2>, The median operative time was 2,5 hours, and 79,2% of the patients had no surgical complications. <3>, In terms of surgical complications, the main surgical complications were positive incision margins (53, 8%), lymphatic fistula (8, 5%), and incisional infection (4, 7%). <4>, In terms of postoperative urinary control recovery, 3 months after surgery, 64, 4% of patients recovered from urinary control without the use of pads, and only 18, 6% of patients required the use of greater than 3 pads. <5>, The median follow-up time after surgery was 22, 8 months, and 88, 7% of the patients were still alive. 4. Review of study conclusions and clinical significance This study found that for patients with metastatic prostate cancer with resectable primary foci, selection of appropriate cases for reduction radical prostatectomy performed by a highly skilled urologist has a safety profile with a surgical complication ratio no higher than that of patients with non-metastatic prostate cancer. This study was retrospective and, like some previous retrospective analyses, further found that radical subtractive resection of the primary site benefited patients with metastatic prostate cancer. However, its findings have not been recommended by European and American treatment guidelines. Several prospective studies have been conducted to explore the value of treatment (radiation therapy or radical prostatectomy) for patients with metastatic prostate cancer at the primary site. We are waiting to see what their findings will be!