男性荷尔蒙敏感型前列腺癌（PCa）转移至非区域淋巴结（M1a）的病人是否受益于前列腺定向治疗（PDT）和/或转移定向治疗（MDT）仍不清楚。为了系统地总结有关新发和复发M1a PCa病人接受PDT和/或 MDT的肿瘤学结果，我们按照系统综述和Meta分析指南，搜索了Medline（Ovid），Embase和Scopus，以了解有腺激素剥夺治疗或无腺激素剥夺治疗下，新发或复发的激素敏感M1a PCa病人接受 PDT（根治性前列腺切除术或放射性治疗）和/或 MDT（淋巴结放射线治疗或挽救性淋巴结切除术）的肿瘤学结果。我们进行了描述性数据综合和方法学质量评估，以评估PDT和/或 MDT对M1a PCa病人生存的影响。 共筛选了6136篇文章，其中24篇纳入了这一系统综述。在新发的M1a PCa病人中，PDT与无PDT相比，其肿瘤学结果有所改善。在复发的M1a PCa中，MDT可以延迟某些患者开始系统治疗的需要，但是迫切需要来自前瞻性III期随机对照试验的高水平证据。 这个系统综述总结了关于M1a PCa管理的有限文献数据。亚组分析表明PDT加系统治疗在新发的M1a PCa中有作用。对于复发性疾病，MDT对远处淋巴结转移的治疗可以延迟系统治疗的开始，但是缺乏强有力的数据支持。纳入研究的主要是回顾性研究，并且研究设计的显著异质性限制了证据的强度。 我们审查了前列腺癌病人治疗在骨盆外淋巴结转移但没有转移至其他器官系统的情况。 有证据表明，在明确选择的患者中，治疗原发前列腺肿瘤可以改善结果，并且治疗靶向远处淋巴结转移可以延迟系统治疗的开始。 版权所有©2022欧洲泌尿协会。 Elsevier B.V.发表。版权所有。

It remains unclear whether men with hormone-sensitive prostate cancer (PCa) metastasized to nonregional lymph nodes (M1a) benefit from prostate-directed therapy (PDT) and/or metastasis-directed therapy (MDT).To systematically summarize the literature regarding oncological outcomes of de novo and recurrent M1a PCa patients treated with PDT and/or MDT.We searched Medline (Ovid), Embase, and Scopus according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines for reports on oncological outcomes of de novo or recurrent hormone-sensitive M1a PCa patients treated with PDT (radical prostatectomy or radiotherapy) and/or MDT (nodal radiotherapy or salvage lymph node dissection) with or without androgen deprivation therapy. A descriptive data synthesis and a methodological quality assessment were performed to evaluate the impact of PDT and/or MDT on survival in M1a PCa patients.A total of 6136 articles were screened and 24 studies were included in this systematic review. In de novo M1a PCa patients, PDT was associated with improved oncological outcomes compared with no PDT. In recurrent M1a PCa, MDT could delay the need for systemic treatment in a selection of patients, but high-level evidence from prospective phase III randomized controlled trials is still awaited.This systematic review summarized the limited literature data on the management of M1a PCa. Subgroup analyses suggest a role for PDT plus systemic therapy in de novo M1a PCa. MDT to distant nodal metastases delayed the need for systemic therapy in recurrent disease, but robust data are lacking. The predominantly retrospective nature of the included studies and significant heterogeneity in study designs limit the strength of evidence.We reviewed the treatment of patients with prostate cancer that has spread to lymph nodes outside the pelvis without metastases in other organ systems. There is evidence that treatment of the primary prostate tumor improves outcomes in well-selected patients and that treatment targeting distant lymph node metastases can delay the start of systemic treatment.Copyright © 2022 European Association of Urology. Published by Elsevier B.V. All rights reserved.