EURURO Vol. 72 No. 3

353 476

in advanced PC that may further confound attribution of
survival advantage to variation in the initial treatment
strategy.
Epidemiologic data in this arena, while thought-provok-
ing and hypothesis-generating, can still be misleading
despite high-fidelity data capture and sophisticated statisti-
cal analysis Thus, examining the present data, we are
cautiously optimistic that continued development and
implementation of high-quality clinical trials with agree-
ment on both well-defined enrollment criteria and stan-
dardized outcome measures will allow us to identify biologic
subsets who may benefit most from local therapy. This will
allow clinicians to apply local therapy in cases for which an
absolute treatment benefit is known, while sparing many
men the morbidity of addition of local therapy to standard
systemic approaches when it is of no benefit.
Conflicts of interest: The authors have nothing to disclose.
References
[1] Culp SH, Schellhammer PF, Williams MB. Might men diagnosed
withmetastatic prostate cancer benefit fromdefinitive treatment of
the primary tumor?. A SEER-based study. Eur Urol 2014;65:1058–
66 .
[2] Gratzke C, Engel J, Stief CG. Role of radical prostatectomy in
metastatic prostate cancer: data from the Munich cancer registry.
Eur Urol 2014;66:602–3.
.
[3] Rusthoven CG, Jones BL, Flaig TW, et al. Improved survival with
prostate radiation in addition to androgen deprivation therapy for
men with newly diagnosed metastatic prostate cancer. J Clin Oncol
2016;34:2835–42.
[4] O’Shaughnessy MJ, McBride SM, Vargas HA, et al. A pilot study of a
multimodal treatment paradigm to accelerate drug evaluations in
early-stage metastatic prostate cancer. Urology 2017;102:164–72.
.
[5] Sooriakumaran P, Nyberg T, Akre O, et al. Survival among men at
high risk of disseminated prostate cancer receiving initial locally
directed radical treatment or initial androgen deprivation therapy.
Eur Urol 2017;72:345–51.
.
[6] Crawford ED, Petrylak DP, Shore N, et al. The role of therapeutic
layering in optimizing treatment for patients with castration-resis-
tant prostate cancer (RADAR II). Urology. In press.
.
[7] Barbieri CE, Chinnaiyan AM, Lerner SP, Swanton C, Rubin MA. The
emergence of precision urologic oncology: a collaborative review
on biomarker-driven therapeutics. Eur Urol 2017;71:237–46.
.
[8] Williams SB, Huo J, Chamie K, et al. Discerning the survival
advantage among patients with prostate cancer who undergo
radical prostatectomy or radiotherapy: the limitations of cancer
registry data: survival advantage with prostatectomy. Cancer
2017;123:1617–24. .
E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 3 5 2 – 3 5 3 353