title: Salvage radical prostatectomy: an alternative treatment for local recurrence of radioresistant cancer.
abstract: OBJECTIVE
  The treatment of recurrent prostate cancer after radiotherapy or brachytherapy through radical prostatectomy has been little indicated due to the concern over the procedure's morbidity. We present the experience of our service with postradiotherapy radical prostatectomy.
  
  
  METHODS
  Between 1996 and 2002, 9 patients submitted to radiotherapy due to prostate cancer were treated with salvage surgery for locally recurrent disease. All patients had a biopsy of the prostate confirming the tumor recurrence, increase in the PSA levels and staging without evidence of a systemic disease. We have assessed the morbidity and the recurrence-free survival rate after salvage radical prostatectomy.
  
  
  RESULTS
  Preradiotherapy PSA varied from 6.2 to 50 ng/mL (mean 17.3) and clinical staging T1, T2 and T3 in 33.3%, 44.4% and 22.2% of the patients respectively. The interval for the biopsy after conforming external beam radiotherapy or brachytherapy varied from 8 to 108 months (median: 36). Four patients received antiandrogenic therapy neoadjuvant to the surgery with a mean of 7 months (1-48) after radiotherapy. From the six patients potent before the surgery, three have presented erectile dysfunction. Urinary incontinence as well as bladder neck sclerosis occurred in two patients (22.2%). Biochemical recurrence occurred in two individuals (22.2%) 12 months after the surgery. Biochemical recurrence-free survival rate was 77.8% with median follow-up time of 30 months (8-102).
  
  
  CONCLUSIONS
  Salvage radical prostatectomy is a safe and effective alternative for the treatment of locally recurrent prostate cancer after radiotherapy and brachytherapy.
authors.affiliation: Department of Urology, Faculty of Medicine, University of Sao Paulo (USP), Sao Paulo, Brazil. marcosdallogliouro@terra.com.br
authors.forename: Marcos F
authors.initials: MF
authors.lastname: Dall'Oglio
authors.forename: Francualdo
authors.initials: F
authors.lastname: Barreto
authors.forename: Mario
authors.initials: M
authors.lastname: Paranhos
authors.forename: Adriano
authors.initials: A
authors.lastname: Nesrallah
authors.forename: Luciano
authors.initials: L
authors.lastname: Nesrallah
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
mesh_terms: D000368:Aged; D001918:Brachytherapy; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D011836:Radiation Tolerance; D016879:Salvage Therapy; D016896:Treatment Outcome