尽管缺乏 1 级证据，转移导向治疗 (MDT) 仍广泛用于转移性前列腺癌 (mPCa) 患者的治疗。精心设计的前瞻性研究不断涌现数据。总结并报告 MDT 治疗 mPCa 患者的肿瘤学和安全性结果的证据。我们在 PubMed、Scopus 和 Web of Science 数据库中检索了评估无进展的前瞻性研究接受 MDT 治疗的 mPCa 患者的生存期 (PFS)、局部控制 (LC)、无雄激素剥夺治疗 (ADT) 生存期 (ADT-FS)、总生存期 (OS) 和/或不良事件 (AE)。对 1 年和 2 年 PFS、LC、ADT-FS、OS 和 AE 发生率进行了荟萃分析。进行荟萃回归和敏感性分析以解释异质性并确定调节因素。我们确定了 22 项前瞻性研究 (n = 1137)，其中包括两项随机对照试验 (n = 116)。两项研究被排除在荟萃分析之外（n = 120）。排除使用生化或 ADT 相关终点的研究后，估计的 2 年 PFS 为 46%（95% 置信区间 [CI]：36-56%）或 42%（95% CI：33-52%）。估计的 2 年 LC、ADT-FS 和 OS 分别为 97% (95% CI: 94-98%)、55% (95% CI: 44-65%) 和 97% (95% CI: 95- 98%），分别。治疗相关的 2 级和 ≥3 级 AE 发生率分别为 2.4% (95% CI: 0.2-7%) 和 0.3% (95% CI: 0-1%)。MDT 是一种有前景的治疗策略，可实现良好的 PFS 、优异的 LC 和低毒性特征，使寡复发激素敏感患者能够避免或推迟 ADT 相关毒性。 MDT 与其他疗法的整合提供了一个有前途的研究方向，特别是与全身治疗相结合，并作为寡转移性 PCa 明确治疗的一部分。然而，在缺乏随机试验的情况下，使用 MDT 进行强化治疗仍然是一种实验方法，对 OS 的影响尚不确定。对于选定的前列腺癌患者来说，直接治疗转移瘤是一种有前途的选择。它可以延迟激素治疗，并且正在研究作为一种以可控毒性为代价强化治疗的方法。版权所有 © 2023 作者。由 Elsevier B.V. 出版。保留所有权利。

Despite the lack of level 1 evidence, metastasis-directed therapy (MDT) is used widely in the management of metastatic prostate cancer (mPCa) patients. Data are continuously emerging from well-designed prospective studies.To summarise and report the evidence on oncological and safety outcomes of MDT in the management of mPCa patients.We searched the PubMed, Scopus, and Web of Science databases for prospective studies assessing progression-free survival (PFS), local control (LC), androgen deprivation therapy (ADT)-free survival (ADT-FS), overall survival (OS), and/or adverse events (AEs) in mPCa patients treated with MDT. A meta-analysis was performed for 1- and 2-yr PFS, LC, ADT-FS, OS, and rate of AEs. Meta-regression and sensitivity analysis were performed to account for heterogeneity and identify moderators.We identified 22 prospective studies (n = 1137), including two randomised controlled trials (n = 116). Two studies were excluded from the meta-analysis (n = 120). The estimated 2-yr PFS was 46% (95% confidence interval [CI]: 36-56%) or 42% (95% CI: 33-52%) after excluding studies using biochemical or ADT-related endpoints. The estimated 2-yr LC, ADT-FS, and OS were 97% (95% CI: 94-98%), 55% (95% CI: 44-65%), and 97% (95% CI: 95-98%), respectively. Rates of treatment-related grade 2 and ≥3 AEs were 2.4% (95% CI: 0.2-7%) and 0.3% (95% CI: 0-1%), respectively.MDT is a promising treatment strategy associated with favourable PFS, excellent LC, and a low toxicity profile that allows oligorecurrent hormone-sensitive patients to avoid or defer ADT-related toxicity. Integration of MDT with other therapies offers a promising research direction, in particular, in conjunction with systemic treatments and as a component of definitive care for oligometastatic PCa. However, in the absence of randomised trials, using MDT for treatment intensification remains an experimental approach, and the impact on OS is uncertain.Direct treatment of metastases is a promising option for selected prostate cancer patients. It can delay hormone therapy and is being investigated as a way of intensifying treatment at the expense of manageable toxicity.Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.