Salvage radical prostatectomy for radiorecurrent adenocarcinoma of the prostate.

A total of 16 patients with persistent or recurrent prostate cancer 1 to 10 years after definitive treatment with radiotherapy underwent salvage radical prostatectomy. Patients considered to be candidates for the procedure were in excellent health, with a life expectancy of at least 10 years and with no evidence of extension of tumor beyond the prostate. There was no operative mortality but major complications included rectal injury in 3 patients (19 per cent, 1 requiring colostomy), ureteral transection in 1 (6 per cent), anastomotic stricture in 4 (25 per cent), ureterovesical junction stricture in 1 (6 per cent) and persistent urinary incontinence in 4. Whole organ step-section of the surgical specimen revealed positive surgical margins in 6 patients (37.5 per cent). Margins usually were positive at the apex and not at the bladder neck, so that cystoprostatectomy would not have altered the positive margin rate. Although the followup is too short for analysis of tumor recurrence or patient survival rates, the results indicate that salvage radical prostatectomy, although technically demanding, is feasible and that in the majority of properly selected patients the tumor can be removed completely.