Objective <p>To investigate the clinical efficacy of cytoreductive surgery in oligometastatic hormone-sensitive prostate cancer (omHSPC).</p> Methods <p>The basic characteristics, treatment strategies and long-term follow-up of 181 patients with omHSPC were retrospectively analyzed. All patients were divided into cytoreductive surgery group and no local therapy group according to the administration of cytoreductive surgery before progression to metastatic castration-resistant prostate cancer (mCRPC). Subsequently, our study explored the effect of cytoreductive surgery on CRPC-free survival in omHSPC patients.</p> Results <p>A total of 181 patients were enrolled in the study, including 48 patients who received cytoreductive surgery and 133 patients who did not receive local therapy. No significant differences were detected between the two groups regarding prostate-specific antigen (PSA) at the initial diagnosis (<i>P</i> = 0.194), the International Society of Urological Pathology (ISUP) grade group (<i>P</i> = 0.158), the treatment options during omHSPC (<i>P</i> = 0.090), common comorbidities (<i>P</i> = 0.649) and the number of metastases (<i>P</i> = 0.291). The proportions of patients with Tx stage (<i>P</i> = 0.027) and Nx stage (<i>P</i> = 0.027) in the no local therapy group were significantly higher than that in the cytoreductive group. After propensity score matching (PSM), it was found that cytoreductive surgery could significantly improve the CRPC-free survival of omHSPC patients (hazard ratio (HR) = 0.537, 95% confidence interval (CI) = 0.317–0.909, <i>P</i> = 0.016).</p> Conclusion <p>Cytoreductive surgery can significantly improve the CRPC-free survival of omHSPC patients. Additionally, large sample-size, prospective and randomized controlled studies are needed to validate the results of our study in the future.</p>