Salvage radical prostatectomy

Abstract

Radical salvage prostatectomy represents a secondary local treatment with curative intent in patients with organ confined PCA recurrences following radiation therapy. Preoperative risk factors predicting organ confined disease are initial LDR brachytherapy, preoperative Gleason biopsy score ≤6, ≤50% biopsy cores involved with cancer, and a PSA doubling time > 12 months. Metastatic disease should be ruled out preoperatively by skeletal scintigraphy, abdominal computed tomography or magnetic resonance imaging, and/or choline - PET/CT. Functionality of the lower urinary tract is evaluated by urethrocystosocopy and urodynamics. Most appropriate candidates for radical salvage prostatectomy are patients with organ confined disease or those with symptomatic local recurrences. In experienced hands, morbidity is low with a continence rate of 83-96% depending on the type of previous radiation therapy. Long-term oncological control can be achieved in more than 80% of the patients.