If your prostate cancer has spread, it is completely understandable to wonder whether removing the prostate could still help. Robotic prostatectomy can remove the prostate itself, but it cannot remove cancer cells that have already travelled to your bones, distant lymph nodes or other organs.
For most men with metastatic prostate cancer, treatment therefore needs to work throughout the body. A small recent randomised trial has suggested that prostatectomy may have a role in carefully selected men with oligometastatic disease, but the evidence is still limited. Surgery is not routine treatment for M1 prostate cancer, and current European guidance recommends that it should only be offered within a clinical trial.
What Does It Mean When Prostate Cancer Has Spread?
If your prostate cancer has spread to distant parts of your body, it is called metastatic or M1 disease. It can commonly spread to your bones, such as the spine, pelvis and ribs, as well as distant lymph nodes or, less commonly, organs such as the lungs or liver.
This is different from cancer that has only grown outside your prostate or reached nearby lymph nodes. Knowing exactly where your cancer has spread helps your doctor decide whether surgery has any role in your treatment.
Can Robotic Prostatectomy Remove Metastatic Prostate Cancer?
If your prostate cancer has spread, robotic prostatectomy can remove your prostate but cannot remove cancer cells elsewhere in your body. For example, surgery cannot remove cancer that has already spread to your bones, distant lymph nodes or other organs.
For this reason, prostatectomy is not considered a curative standalone treatment for metastatic prostate cancer. If surgery is considered, it would usually be part of a wider treatment plan rather than a replacement for treatments that work throughout your body.
What Is the Standard Treatment When Prostate Cancer Has Spread?
If you have newly diagnosed hormone-sensitive metastatic prostate cancer, treatment usually centres on systemic therapy that can reach cancer cells throughout your body. Androgen deprivation therapy (ADT) is generally combined with additional treatment when you are fit enough for combination therapy, rather than routinely being used alone.
Depending on your individual situation, ADT may be combined with an androgen-receptor pathway treatment such as enzalutamide, apalutamide, darolutamide or, in appropriate circumstances, abiraterone. Docetaxel may also form part of treatment for some men, including as part of an intensified combination regimen. The treatment available to you will depend on factors such as the extent of your cancer, your fitness and other health conditions, previous treatment and the relevant NICE eligibility criteria.
| Treatment approach | What it targets | Current role in metastatic disease |
| ADT and other systemic medicines | Cancer cells throughout the body | Central part of treatment |
| Docetaxel-containing systemic therapy | Cancer throughout the body | Used in selected men as part of combination treatment |
| Radiotherapy to the prostate | Primary prostate tumour | Established option for selected men whose first presentation is low-volume M1 disease by CHAARTED criteria |
| Radical/robotic prostatectomy | Primary prostate tumour | Investigational in M1 disease; not routine standard care |
| Metastasis-directed radiotherapy | Individual metastatic deposits | Investigational in M1 disease; EAU recommends use within a clinical trial or well-designed prospective cohort study |
Why Is Surgery Not Normally the First Treatment for Metastatic Disease?
If your prostate cancer has spread, removing your prostate does not treat cancer elsewhere in your body. You therefore usually need treatments that can reach cancer cells throughout your body.
Surgery can also cause side effects such as urinary incontinence and erectile dysfunction. Although research into cytoreductive prostatectomy is continuing, current EAU guidance gives a strong recommendation not to combine ADT with surgery for M1 prostate cancer outside a clinical trial. This reflects continuing uncertainty about which patients benefit enough to justify the additional surgical risks.
Why Are Researchers Studying Cytoreductive Prostatectomy?
If your prostate cancer has spread, removing your prostate will not eliminate cancer that is already elsewhere in your body. Researchers are instead investigating whether reducing the amount of tumour in the prostate could improve cancer control or reduce future problems from the primary tumour when surgery is added to systemic treatment. This approach is known as cytoreductive prostatectomy.
Robotic surgery may be used to remove the prostate, but treatment that works throughout your body is still needed. Recent randomised evidence has made this approach more interesting in carefully selected men with oligometastatic disease, but it remains investigational rather than routine treatment.
What Is Oligometastatic Prostate Cancer?
If you have only a small number of detectable areas of metastatic prostate cancer, you may be described as having oligometastatic disease. These deposits can occur in your bones or lymph nodes, although there is no single definition of how many metastases this includes.
This distinction can matter when doctors consider treatment options. However, oligometastatic cancer has still spread, so systemic treatment remains an important part of your care.
Oligometastatic disease and ‘low-volume’ metastatic disease are related concepts but are not interchangeable. Oligometastatic disease generally refers to a small number of detectable metastatic sites, while low-volume disease in major prostate cancer trials has been defined using specific criteria based on the number and location of metastases.
What Does ‘Low-Volume’ Metastatic Prostate Cancer Mean?
Low-volume metastatic prostate cancer is defined using specific clinical-trial criteria rather than simply counting whether there are ‘a few’ metastases. Under the commonly used CHAARTED definition, high-volume disease includes visceral metastases or at least four bone metastases with one or more beyond the spine or pelvis. Disease that does not meet those criteria is classed as low-volume.
It is also important to remember that the CHAARTED criteria were developed using conventional imaging such as CT and bone scans, so they cannot always be applied directly to very small deposits detected only on PSMA PET/CT.
However, evidence for radiotherapy does not mean surgery offers the same benefit. Your doctor will consider the number and location of your metastases when planning treatment.
Can Treating the Prostate Help Even When Cancer Has Spread?
Treating the prostate itself can improve outcomes in selected men whose prostate cancer is metastatic when first diagnosed. In the STAMPEDE randomised trial, prostate radiotherapy improved overall survival in men with low metastatic burden, although no overall-survival benefit was found in men with high-burden disease.
In the low-burden group, the long-term analysis found an overall-survival hazard ratio of 0.64 (95% confidence interval 0.52–0.79). This provides much stronger randomised evidence for prostate radiotherapy than currently exists for prostatectomy in metastatic disease.
However, this does not mean removing your prostate will provide the same benefit. Your doctor will consider where your cancer has spread, how much is present and which treatments are most suitable for you.
What Has Research Shown About Prostatectomy So Far?
Recent research has made the evidence for surgery more interesting, but it has not yet established prostatectomy as routine treatment. The RAMPP randomised trial studied 132 men with oligometastatic prostate cancer who received either best systemic treatment alone or systemic treatment plus radical prostatectomy.
At five years, the cumulative incidence of prostate-cancer-specific mortality was 13% with surgery plus best systemic treatment compared with 23% with systemic treatment alone. The hazard ratio for prostate-cancer-specific mortality was 0.39 (95% confidence interval 0.16–0.98). However, the trial stopped recruitment early, included only 132 men and did not show a statistically significant overall-survival benefit. Major surgery-related complications, classified as Clavien–Dindo grade III or higher, occurred in 9 of the 66 men who underwent prostatectomy. These findings are encouraging, but the study is too limited to establish prostatectomy as routine treatment for metastatic disease.
What Research Is Still Under Way?
Further randomised research is continuing despite the recently reported RAMPP results. The SWOG S1802 phase III trial compares standard systemic therapy with systemic therapy plus definitive treatment of the prostate, using either surgery or radiotherapy.
The trial should help clarify whether treating the primary prostate tumour alongside systemic therapy improves outcomes. Because men in the definitive-treatment group may receive either surgery or radiotherapy, the results should provide broader information about treating the prostate itself rather than showing the effect of surgery alone.
Who Might Be Considered for Surgery in a Clinical Trial?
Surgery may be studied in carefully selected men with metastatic prostate cancer. Your overall health and the extent of your cancer are important when assessing eligibility.
- Limited spread: A small number of metastatic sites may make you more suitable for certain trials.
- Good general health: You need to be fit enough to undergo major prostate surgery.
- Treatment response: Your response to initial systemic treatment may influence trial eligibility.
- Removable tumour: Your prostate cancer must be technically suitable for surgical removal.
Clinical-trial requirements vary between studies. Your specialist team can explain whether an appropriate trial may be available for you.
Can Robotic Prostate Surgery Remove Metastases Elsewhere?
Robotic prostatectomy removes the prostate and does not remove metastatic deposits in bones, distant lymph nodes or other organs. In selected patients with a small number of metastatic sites, focused radiotherapy to individual metastases may be considered in specialist settings, although current European guidance still regards metastasis-directed treatment for M1 disease as an area requiring further prospective evidence.
Your treatment may therefore involve systemic therapy, treatment to your prostate and, in some cases, treatment to individual metastases. Which combination is right for you will depend on where your cancer has spread and your overall situation.
What Are the Risks of Robotic Prostatectomy in Metastatic Disease?
If you have robotic prostatectomy, you may experience urinary leakage or erectile dysfunction afterwards. You may also face risks such as bleeding, infection, blood clots or narrowing where your bladder and urethra are joined.
These risks are particularly important because prostatectomy has not yet demonstrated a statistically significant overall-survival benefit in randomised evidence and remains investigational for M1 prostate cancer. Your doctor should therefore discuss the potential benefits and risks carefully before you consider surgery.
Could Surgery Prevent Urinary Problems Later?
If your prostate tumour grows, it may eventually cause urinary blockage, bleeding or bladder problems. Removing your prostate could potentially reduce some of these risks, which is one reason doctors continue to study this approach. However, preventing future urinary complications is not currently a proven reason to offer routine prostatectomy for metastatic disease.
Surgery can also cause urinary leakage and other complications. Your doctor will therefore weigh your risk of future problems against the risks of surgery and consider other treatments that may control your symptoms.
Does PSMA PET/CT Change the Decision?
If you have a PSMA PET/CT, your doctors may see smaller areas of prostate cancer spread that older scans could miss. This can help your team understand how much cancer you actually have and where it is.
However, older research often used CT scans and bone scans instead. Your doctor therefore needs to interpret your modern scan carefully before applying older treatment evidence to your situation.
What If You Have Only Lymph-Node Spread?
If your prostate cancer is found in lymph nodes, your treatment will depend on which nodes are affected. Regional pelvic lymph-node involvement is generally classified as N1 disease rather than M1 metastatic disease, whereas spread to non-regional lymph nodes is classified as M1a disease.
Your scans, such as MRI or PSMA PET/CT, can help your doctor understand where the cancer has spread. You therefore need to know whether the affected nodes are regional or distant before deciding if prostatectomy is suitable.
When Do Symptoms Need Urgent Assessment?
If you develop new weakness in a limb, difficulty walking, numbness or altered sensation, or new problems controlling your bladder or bowel, seek immediate medical assessment. These can be signs of metastatic spinal cord compression, which is an oncological emergency.
If you develop severe, persistent or progressively worsening back pain particularly pain that wakes you at night or becomes worse with movement, coughing, sneezing or straining contact your cancer team urgently. NICE advises specialist assessment within 24 hours when symptoms suggest spinal metastases.
Why Should Your Treatment Be Discussed by a Specialist Team?
If your prostate cancer has spread, your treatment should be assessed within a multidisciplinary plan rather than from a surgical perspective alone. A specialist team can review your scans, cancer spread, symptoms and overall health to decide which treatments are most suitable for you.
If you are considering robotic prostate surgery, your team should also explain how surgery compares with other treatments. The important question is whether surgery has a meaningful role in your complete treatment plan.
UK Guidance Note
UK treatment for metastatic hormone-sensitive prostate cancer has changed significantly in recent years. NICE now supports several intensified systemic options in addition to ADT, including enzalutamide, apalutamide and darolutamide in defined populations, while abiraterone plus ADT is now an NHS option for newly diagnosed high-risk hormone-sensitive metastatic disease.
Because NICE recommendations for these medicines have changed over time, your treatment options should be based on the latest NICE guidance as well as the characteristics of your cancer, your overall health and which treatments are suitable for you. Current European guidance remains clear that prostatectomy for M1 disease should not be offered outside a clinical trial.
What Should You Ask If Surgery Has Been Suggested?
If your doctor has suggested surgery, ask why they think it could benefit you despite the cancer having spread. You should also ask how many metastases you have, where they are and whether your cancer is considered low-volume or oligometastatic.
Ask whether radiotherapy or a clinical trial may be better options for you. You should also understand which systemic treatments you will still need and what urinary or sexual side effects you could experience.
Myth vs Fact
| Myth | Fact |
| Removing the prostate removes all metastatic prostate cancer. | No. Prostatectomy removes the primary tumour but does not remove cancer cells already present in bones, distant lymph nodes or other organs. |
| Prostate surgery is now standard treatment for oligometastatic disease because of RAMPP. | No. RAMPP is encouraging, but it was small, stopped recruitment early and did not show a statistically significant overall-survival benefit. |
| RAMPP proved that robotic surgery improves survival. | No. RAMPP tested radical prostatectomy as a treatment strategy; it was not a trial designed to prove a metastatic-cancer survival advantage specifically from the robotic approach. |
| Radiotherapy and surgery have the same level of evidence in low-volume M1 disease. | No. Randomised evidence supporting prostate radiotherapy is substantially stronger, and current EAU guidance recommends it for de novo low-volume M1 disease. |
| A few lesions on PSMA PET automatically mean the same thing as low-volume disease in older trials. | No. CHAARTED/STAMPEDE definitions were based mainly on conventional imaging, so PSMA PET stage migration needs careful interpretation. |
Key Takeaways
- Robotic prostatectomy can remove the prostate, but it cannot remove metastatic cancer elsewhere in your body.
- For most men with M1 prostate cancer, systemic treatment remains central, usually using ADT with additional treatment when appropriate.
- Prostate radiotherapy has established randomised evidence for men presenting with low-volume metastatic disease, while prostatectomy remains investigational.
- RAMPP produced encouraging results for selected oligometastatic patients, but the trial was small and did not establish a statistically significant overall-survival benefit.
- Current European guidance recommends prostate surgery for M1 disease only within clinical trials.
Frequently Asked Questions
1. Can robotic prostate surgery cure metastatic prostate cancer?
No. Robotic prostatectomy can remove the prostate but cannot remove cancer that has already spread to bones, distant lymph nodes or other organs. Metastatic prostate cancer usually requires treatment that works throughout your body.
2. Is robotic prostatectomy routinely used for metastatic prostate cancer?
No. Surgery is not currently routine treatment for metastatic disease. It may be considered in carefully selected situations or as part of a clinical trial while researchers continue to assess its potential benefits.
3. What treatments are usually used when prostate cancer has spread?
Treatment commonly includes hormone therapy, also called androgen deprivation therapy (ADT), often combined with another medicine. Depending on your cancer and overall health, your doctor may also discuss chemotherapy or other systemic treatments.
4. Is Low-Volume Metastatic Disease the Same as Oligometastatic Disease?
Not exactly. Low-volume disease is usually defined using specific clinical-trial criteria, while oligometastatic disease generally describes cancer with a limited number of detectable metastatic sites. The terms can overlap but should not be used interchangeably.
5. Could Surgery Help When There Are Only a Few Metastases?
Recent randomised evidence suggests that radical prostatectomy may have a role in carefully selected men with oligometastatic prostate cancer, but the evidence remains limited. The RAMPP trial was relatively small and did not demonstrate a statistically significant overall-survival benefit, so prostatectomy is not currently routine treatment for M1 disease.
6. Does treating the prostate help if the cancer has spread?
Treating the prostate may provide benefits in selected men with metastatic disease, but the strongest evidence for prostate-directed treatment is currently associated with radiotherapy rather than prostatectomy. Your doctor will consider the extent and location of your cancer when discussing your options.
7. Can robotic surgery remove cancer from my bones or other organs?
No. Robotic prostatectomy removes the prostate and cannot remove metastatic deposits elsewhere in your body. If you have a small number of metastases, your specialist team may discuss focused radiotherapy in carefully selected circumstances, although current European guidance still regards metastasis-directed treatment for M1 disease as investigational.
8. Why Can PSMA PET/CT Complicate Treatment Decisions?
PSMA PET/CT can detect smaller metastatic deposits than conventional imaging. However, important clinical trials defining low-volume disease and demonstrating the benefit of prostate radiotherapy largely used CT and bone scans, so modern PSMA PET findings need to be interpreted carefully.
9. What are the risks of robotic prostatectomy?
Potential risks include urinary leakage, erectile dysfunction, bleeding, infection and blood clots. You may also develop narrowing at the connection between your bladder and urethra, although this is not common.
10. When Does Metastatic Prostate Cancer Require Emergency Assessment?
New limb weakness, difficulty walking, numbness, altered sensation or new bladder or bowel dysfunction can indicate spinal cord compression and require immediate medical assessment. Significant new or worsening back pain should also be reported promptly.
Final Thoughts: Does Robotic Surgery Have a Role in Metastatic Prostate Cancer?
If your prostate cancer has spread, robotic prostate surgery is not usually a standalone treatment because it cannot remove cancer that has reached other parts of your body. Recent randomised evidence suggests that radical prostatectomy may eventually have a role for carefully selected men with oligometastatic disease, but the evidence remains limited and current guidelines do not recommend surgery as routine treatment for M1 prostate cancer. Where surgery is being considered, it should form part of a specialist multidisciplinary discussion and, under current European guidance, a clinical-trial setting.
The decision should be based on where your cancer has spread, how much disease is present, your overall health and the evidence supporting each treatment option. Your specialist team can explain whether surgery, radiotherapy, systemic treatment or a clinical trial is most appropriate for your individual situation.
If you are looking for robotic prostate surgery in London, you can arrange a consultation with our team to discuss whether surgery may be appropriate for you and receive personalised advice about your diagnosis and treatment options.
References:
- National Institute for Health and Care Excellence (NICE) (2025) Abiraterone (originator and generics) for treating newly diagnosed high-risk hormone-sensitive metastatic prostate cancer. NICE technology appraisal guidance TA1110. Published 19 November 2025. The associated NICE resource-impact guidance incorporates relevant treatment guidance for darolutamide, apalutamide and enzalutamide in hormone-sensitive metastatic prostate cancer. Available at: https://www.nice.org.uk/guidance/ta1110/resources/resource-impact-template-excel-15494650669
- European Association of Urology (EAU) (2026) EAU Guidelines on Prostate Cancer: Treatment. Available at: https://uroweb.org/guidelines/prostate-cancer/chapter/treatment
- Parker, C.C. et al. (2022) ‘Radiotherapy to the prostate for men with metastatic prostate cancer in the UK and Switzerland: long-term results from the STAMPEDE randomised controlled trial’, PLOS Medicine, 19(6), article e1003998. Available at: https://pubmed.ncbi.nlm.nih.gov/35671327/
- Graefen, M., Falkenbach, F., Maurer, T. et al. (2026) ‘Best systemic therapy with or without radical prostatectomy in the management of men with oligometastatic prostate cancer: the RAMPP randomised controlled trial’, European Urology, 90(2), pp. 116–124. Available at: https://pubmed.ncbi.nlm.nih.gov/41046179/
- National Institute for Health and Care Excellence (NICE) (2023) Spinal metastases and metastatic spinal cord compression. NICE guideline NG234. Published 6 September 2023. Available at: https://www.nice.org.uk/guidance/ng234
- SWOG Cancer Research Network (2025) S1802: Phase III Randomized Trial of Standard Systemic Therapy Versus Standard Systemic Therapy Plus Definitive Treatment (Surgery or Radiation) of the Primary Tumor in Metastatic Prostate Cancer. Available at: https://www.swog.org/clinical-trials/s1802
- Hofman, M.S. et al. (2020) ‘Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study’, The Lancet, 395(10231), pp. 1208–1216. Available at: https://pubmed.ncbi.nlm.nih.gov/32209449/