Radical prostatectomy after radiation therapy for cancer of the prostate: feasibility and prognosis.

A total of 30 patients underwent an operation (radical prostatectomy in 27 and cystoprostatectomy in 3) for prostate cancer. In 17 patients radiotherapy with curative intent (range 5,700 to 7,500 cGy., mean 6,130 cGy.) had failed locally at 7 to 150 months (mean 48.8 months) later; 13 underwent the operation 2 months or less after planned radiotherapy (4,000 to 7,000 cGy., mean 5,431 cGy.). Followup was 1 to 16 years (mean 6.7 years). There was no perioperative death. The most significant complications were vesical neck contracture (17 per cent), lymphedema (10 per cent) and incontinence (10 per cent). Pathological staging revealed 8 patients with stage D1 disease. Of tumor grade, stage, adjuvant hormonal treatment and ploidy pattern only the last was associated with progression and survival. An increasing number of patients with local, albeit often symptomatic, radiation failure may present during the next years and they must be treated. Salvage prostatectomy is feasible and its associated morbidity seems to be acceptable; alternative (nonoperative) treatment modalities have proved not to be effective. Deoxyribonucleic acid ploidy pattern can provide valuable prognostic information in this difficult patient population for decision-making regarding radical surgery and adjuvant hormonal treatment.