I often discuss the use of salvage radiation after surgery has failed and the PSA begins to rise. Although often mentioned, but seldom used, men who fail radiation as a primary treatment can also benefit from salvage surgery. When I first was deciding what to use as my primary treatment modality I was led to believe that salvage surgery could not be preformed post radiation because “the prostate is just mucked up”.

In reality a salvage radical prostatectomy can be considered for men with locally recurrent prostate cancer after external beam radiotherapy has failed. Between 2001 and 2004, Leonardo C, Simone G, Papalia R, Franco G, Guaglianone S, Gallucci M. from the Department of Urology, University of Rome, Rome, Italy, treated 32 men who had undergone radiotherapy with curative intent for prostate cancer. Subsequently they were treated with salvage surgery for clinically localized prostate cancer once their PSA scores again began to rise.

They assessed the morbidity associated with this procedure and the outcome of these 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, intraoperative 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 diseas