A small study out of the Department of Urology, University of Rome, Rome, Italy has demonstrated that a salvage radical prostatectomy is a reasonable treatment option for men with locally recurrent prostate cancer after external beam radiotherapy failure. Despite the traditional belief that surgery can not follow failed radiation treatment, this argument against initial radiotherapy seems to hold less water as an argument.

Between 2001 and 2004, 32 men who were treated with curative intent with radiotherapy for prostate cancer where examined in this very small study. After the failure of the radiotherapy they were subsequently treated with salvage surgery for clinically localized prostate cancer.

The study assessed the morbidity associated with the surgery and the outcomes of the men. Initial pre-radiation median prostate-specific antigen was 13 ng/ml. Pre-radiation disease was clinical stage T1b in five cases, T2a in 10, T2b in 10 and T3a in seven. Mean operative time was 122 minutes, intra-operative blood loss was 550 ml and hospital stay and catheterization time were 5 and 12 days, respectively.

There was biochemical failure in eight patients after salvage radical prostatectomy and 24 patients are biochemical non-evidence of disease (NED). In recurrent prostate local disease with prostate-specific antigen < 10 ng/ml and life expectancy greater than 10 years. Conclusion: Salvage surgery can be a viable treatment option if you initially had radiotherapy that then failed leaving you with localized disease. Reference: Int J Urol. 2009 Jun;16(6):584-6. doi:10.1111/j.1442-2042.2008.02209.x, Leonardo C, Simone G, Papalia R, Franco G, Guaglianone S, Gallucci M. PubMed Abstract PMID:19453762 Joel T Nowak MA, MSW