Objective: The objective of this study was to evaluate salvage radical prostatectomy after failure of radiotherapy for localized prostate cancer.
Material and method: The literature published between 1984 and 2002 was reviewed by a MEDLINE search using the following key words: prostate cancer, radiotherapy, salvage radical prostatectomy.
Results: A total of 404 cases of salvage radical prostatectomy were identified, including 287 radical prostatectomies and 117 radical cystoprostatectomies. Patient selection criteria for this type of surgery were: good general state with a life expectancy of at least 10 years, tumour recurrence with no signs of local or distant extension, histological evidence a minimum of 12 months after radiotherapy and PSA level less than 10 ng/ml before radiotherapy and surgery. The mean rectal injury rate was 7% (range: 0% to 28%) and the mean incontinence rate was 37% (range: 0% to 80%). Histologically, the mean rate of prostate-confined tumours was 34% (range: 20% to 60%), a mean seminal vesicle invasion rate of 36% (range: 25% to 50%) and a mean positive surgical margins rate of 36% (range: 15% to 67%). This second-line treatment was effective in terms of long-term survival, with a specific 10-year survival of 70%.
Conclusion: Radical prostatectomy after failure of radiotherapy is associated with considerable morbidity, but can achieve a good 10-year survival rate in carefully selected patients.