Sequential treatment for recurrent localized prostate cancer.

To compare toxicity and efficacy of both salvage prostatectomy and salvage radiotherapy for prostate cancer a retrospective analysis was conducted. Thirty-two and 41 patients were treated with external beam radiotherapy or prostatectomy for cT1c-T2 prostate cancer later requiring salvage surgery or radiotherapy. Salvage surgery was performed when a local recurrence was biopsy confirmed and life-expectancy was more than 10 years. Salvage external beam radiotherapy was performed when PSA rose over 0.1 ng/ml in the absence of systemic disease. Ten-year PSA-recurrence free survival after primary treatment in the salvage surgery group and salvage radiotherapy groups was 55% and 44% (P > 0.05) respectively whereas prostate cancer specific survival was 93% and 89%, respectively (P > 0.05). Both, biopsy Gleason score prior to primary treatment and PSADT prior to salvage treatment were predictive of PSA-recurrence free survival. Patients after salvage radiotherapy (13%) were less likely to wear pads for urinary incontinence compared to patients after salvage surgery (56%). Erectile dysfunction was more frequent after salvage surgery (81%) compared to salvage radiotherapy (61%). Salvage surgery and salvage prostatectomy after primary cT1-2 prostate cancer provide comparable PSA-recurrence free survival after primary treatment. Genitourinary functions were better preserved in the salvage radiotherapy group compared to the salvage prostatectomy group.