Salvage Surgery Following Radical Radiotherapy for Adenocarcinoma of the Prostate

The development and proliferation of modern radiotherapy techniques, and their application in the 1970s to the treatment of localized adenocarcinoma of the prostate have led to substantial improvement in therapy of this disease. However, treatment failures occur. Among these patients is a small subset who have local recurrence of disease confirmed by biopsy without evidence of metastatic disease, and who still are relatively young and healthy. We report on 7 patients who satisfy these criteria. All 7 patients underwent a salvage operation with removal of the prostate gland following attempted curative radiotherapy: 3 underwent cystoprostatectomy and urinary diversion, and 4 underwent radical prostatectomy. Operating times averaged 4.9 hours and average blood transfusion was 5.3 units. Postoperative hospital stay averaged 13 days. Significant morbidity included 2 patients with rectal lacerations (1 of whom suffered a rectourethroperineal fistula that closed spontaneously), 2 with temporary urinary incontinence, and 1 with idiopathic thrombocytopenia and pseudomembranous colitis. As illustrated by these patients salvage surgery is difficult and there is substantial morbidity. However, this treatment option with its potential for cure can be offered to patients as a reasonable and rational approach to the problem.