title: Salvage open radical prostatectomy after failed radiation therapy: a single center experience.
abstract: BACKGROUND
  Currently there is no universally accepted approach for the management of radiation-recurrent prostate cancer. The aim of this study was to detail our experience performing salvage radical prostatectomy for patients who failed primary treatment of prostate cancer with radiation therapy.
  
  
  METHODS
  We retrospectively queried our institutional database of radical prostatectomy cases for patients who underwent salvage surgery for radiation-recurrent prostate cancer. Patients were assessed for the risk of complications and oncologic outcomes following salvage surgery.
  
  
  RESULTS
  Twenty-four patients with a mean age of 65 years (range 51-74) underwent salvage radical prostatectomy. Fourteen of these patients (58%) received androgen deprivation therapy prior to surgery. Intraoperatively, mean blood loss was estimated at 415 mL (range 100-1000) and 19 (79%) patients received autologous blood. No patient required an allogeneic transfusion or experienced a rectal injury. Postoperative bladder neck contracture and urinary incontinence developed in 17% and 39% of men, respectively. Two (29%) of seven patients remained potent after salvage surgery. No patient developed a fistula. Overall and recurrence-free survival at 5-years was 90% and 39%, respectively. On multivariate analysis, extracapsular extension was the only significant predictor of biochemical recurrence (HR 6.9, 95% CI 1.9-25.3 p = 0.003).
  
  
  CONCLUSIONS
  In carefully selected patients, salvage radical prostatectomy for radiation-recurrent prostate cancer is a treatment option with acceptable oncologic outcomes and a moderate complication rate.
authors.affiliation: Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gorin
authors.affiliation: Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Murugesan
authors.initials: M
authors.lastname: Manoharan
authors.affiliation: Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Galaxy
authors.initials: G
authors.lastname: Shah
authors.affiliation: Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Eldefrawy
authors.affiliation: Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Soloway
keywords: biochemical recurrence; prostate cancer; radiation therapy; salvage radical prostatectomy