Radical prostatectomy and exenterative procedures for local failure after radiotherapy with curative intent: comparison of outcomes.

During the last 2 decades 62 patients without evidence of distant disease underwent salvage surgery, including radical prostatectomy in 32, anterior exenteration in 23 and total exenteration in 7. Mean followup was 3.7 years, mean radiation dosage was 6,083 cGy. (range 3,060 to 7,400) and interval from irradiation to surgery was 6 to 98 months (mean 48 months). The 5-year nonprogression and cause-specific survivals for radical prostatectomy patients of 82% and 90%, respectively, were significantly (p = 0.0062) better than for patients having exenterative procedures. Despite the more extensive local procedure for larger tumors used in exenteration, the residual cancer rate was higher and local control was not improved. Median time to progression after radical prostatectomy and exenterative procedures was 7.5 and 1.3 years, respectively. Progression and cancer death were related to aneuploid status and, in particular, to hormonal treatment and its timing, with the best results obtained when adjuvant hormonal treatment was used for nonaneuploid tumors. Complications were more frequent than after primary prostate surgery. Salvage exenterative procedures seem to be of questionable benefit because of rapid disease progression. Prostatectomy, if feasible, appears to be an acceptable treatment for these difficult cases.