title: Salvage radical prostatectomy after external beam radiation therapy: a systematic review of current approaches.
abstract: BACKGROUND
  Radical external beam radiotherapy (EBRT) is a standard treatment for prostate cancer patients. Despite this, the rate of intraprostatic relapses after primary EBRT is still not negligible. There is no consensus on the most appropriate management of these patients after EBRT failure. For these patients, local salvage therapy such as radical prostatectomy, cryotherapy, and brachytherapy may be indicated.
  
  
  OBJECTIVE
  The objectives of this review were to analyze the eligibility criteria for careful selection of appropriate patients and to evaluate the oncological results and complications for each method.
  
  
  METHODS
  A review of the literature was performed to identify studies of local salvage therapy for patients who had failed primary EBRT for localized prostate cancer.
  
  
  RESULTS
  Most studies demonstrated that local salvage therapy after EBRT may provide long-term local control in appropriately selected patients, although toxicity is often significant.
  
  
  CONCLUSIONS
  Our results suggest that for localized prostate cancer recurrence after EBRT, the selection of a local treatment modality should be made on a patient-by-patient basis. An improvement in selection criteria and an integrated definition of biochemical failure for all salvage methods are required to determine which provides the best oncological outcome and least comorbidity.
authors.affiliation: Division of Urology, European Institute of Oncology, Milan, Italy.
authors.forename: Deliu Victor
authors.initials: DV
authors.lastname: Matei
authors.forename: Matteo
authors.initials: M
authors.lastname: Ferro
authors.forename: Barbara Alicja
authors.initials: BA
authors.lastname: Jereczek-Fossa
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Renne
authors.forename: Nicolae
authors.initials: N
authors.lastname: Crisan
authors.forename: Danilo
authors.initials: D
authors.lastname: Bottero
authors.forename: Claudia
authors.initials: C
authors.lastname: Mazzarella
authors.forename: Daniela
authors.initials: D
authors.lastname: Terracciano
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.forename: Ottavio
authors.initials: O
authors.lastname: De Cobelli
mesh_terms: D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local; D018579:Patient Selection; D011468:Prostatectomy / Q000009:adverse effects / Q000401:mortality; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D012307:Risk Factors; D016879:Salvage Therapy; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome