Prostate cancer (PCa) is a common disease that causes significant mortality rates. The widespread use of more sophisticated imaging methods has led to the identification of oligometastatic PCa, which has a limited number of metastases. Local therapy (radical prostatectomy and/or radiotherapy) for the primary tumor and metastasis-directed therapies have been proposed. A number of retrospective analyses have been conducted in this patient group to determine the place of systemic treatment, which is still the recommended standard treatment for metastatic disease. These studies were based on the aims of improving survival, protecting the patient from the potential side effects of systemic therapy, and eliminating local prostate-related symptoms. Although the studies were retrospective in nature, a survival advantage has been demonstrated in patients receiving local treatment or metastasis-directed treatments. It has been also shown in these studies that local treatment has no effect, at least no detrimental effect, on non-oncologic outcomes. However, these studies have significant limitations, primarily their retrospective design, differences in definitions and end-points used, and patient selection biases. Nevertheless, these results are clinically valuable and can be utilized in practice in some special cases. This patient group needs comprehensive standardization and risk stratification. Determining the definition, staging, treatment, and which patients will benefit from local treatment is essential. With ongoing prospective studies, it is expected that these uncertainties will be resolved and there will be revolutionary changes in the treatment of oligometastatic PCa in the near future.