Median survival of patients with newly diagnosed metastases (synchronous mHSPC) is approximately 50 months with ADT alone. The one of current treatment for mHSPC is ADT with NHA. In recent years, several studies showed that after the disease well control with stable PSA level and regression change in image, cytoreductive surgery for low-volume metastatic prostate cancer had some overall survival benifit. Therefore, it maybe a feasible, safe, and potentially effective therapy in selected patients with mHSPC.

We present a 69-year-old Male with history of Prostate adenocarcinoma with T3 spine and left pubic bone metastasis, Gleason score: 4 + 4 ＝ 8, iPSA: 262, cT4N1M1, stage IVB, the initial treatment was Degarelix + Enzalutamide, Denosumab was also given, but hold due to osteonecrosis of the jaws. After 6 months followed up, the PSA decreased to 0.04 ng/ml, the CT, MRI and bone scan showed regression change. Then the Cytoreductive Retzius-sparing robot-assisted radical prostatectomy was arranged, and the pathology showed ypT3bN0, follow up PSA was undetectable (<0.025ng/ml). The cystography was performed and showed no urine leakage, the functional outcome was also well.

We collected about 4 cases of mHSPC who accepted neoadjuvant ADT with ARSIs and performed cytoreductive RS-RARP, the final pathology were downstaging and follow up PSA were undetectable.

ARSIs add ADT role in enhancing feasibility of cytoreductive prostatectomy for mHSPC. Remarkable radiographic regression with profound, prompt, and persistent PSA reduction were noted.