Salvage radical prostatectomy for locally recurrent prostate cancer following primary radiotherapy

Diagnosis and treatment of post radiotherapy locally recurrent prostate cancer is quite challenging for clinicians. Salvage treatment options in such cases are radical prostatectomy (SRP), cryotherapy (SCT), brachytherapy (SBT) and HIFU (SHIFU). Despite some retrospective studies, definitive conclusions can not be made about the superiority of these treatment options due to lack of prospective and comparative studies. SRP is a good option with its acceptable oncological outcomes and long follow up period compared to other minimally invasive methods. Challenges about the surgical technic and morbidities related with surgery are disadvantages of SRP. As well as open, laparoscopic and robotic approaches can also be performed. However, there isn't enough data to adequately compare the success of these approaches yet. European and American cancer guidelines point out the most important criteria for SRP candidates: pre-radiotherapy localized cancer, cancer confirmed with post-radiotherapy prostate biopsy, no evidence of distant metastases and enough life expectancy to see the results of treatment. The prognostic efficacy of pre-radiotherapy PSA velocity, interval for biochemical recurrence, PSA doubling time, pre-SRP PSA level, Gleason score of prostate biopsy, clinical stage on SRP have been investigated by many scientists. The ideal candidate for SRP must have a pre-SRP PSA value of < 10ng\ml, Gleason score <= 6, > 10 years of life expectancy, and T1c-T2a stages before primary treatment. As a result SRP promotes adequate cancer control with acceptable morbidity and functional recovery in well selected locally recurrent prostate cancer patients.