The indications for radical prostatectomy (RP) in newly diagnosed metastatic prostate cancer (mPCa) patients require further clarification.

Newly diagnosed mPCa patients were identified from the Surveillance, Epidemiology, and End Results (SEER) database and divided into biopsy and RP groups. Propensity score matching (PSM) was used to balance baseline characteristics. Kaplan-Meier curves were used to estimate cancer-specific survival (CSS). Exploratory analysis divided the patients into those with low tumor burden and those with high tumor burden and explored the benefits of RP in patients with different tumor burdens.

A total of 9,215 patients were included, with 8,844 patients undergoing biopsy alone and 371 patients undergoing RP. After PSM, 321 patients in each group were included. Compared with the biopsy group, CSS was significantly improved in the RP group (HR=0.38, 95% CI, 0.27-0.54, p<0.001). Subgroup analysis indicated that RP improved survival across all tumor burden subgroups except for M1c (HR=0.55, 95% CI, 0.21-1.46, p=0.229) and PSA ≥60 ng/ml (HR=1.19, 95% CI, 0.53-2.86, p=0.673). Exploratory analysis suggested that RP significantly improved CSS in the low tumor burden group (PSA <60 ng/ml and M1a/M1b) (HR=0.30, 95% CI, 0.20-0.46, p<0.001), but not in the high tumor burden group (PSA ≥60 ng/ml or M1c) (HR=0.98, 95% CI, 0.53-1.84, p=0.961).

In patients with newly diagnosed mPCa, the survival benefit of RP varies with tumor burden, which needs further validation.