Salvage radical prostatectomy

Although technically challenging, salvage prostatectomy for radiorecurrent prostate cancer is an effective option in carefully selected patients and offers the best chance for cure and long-term survival. Alternatively, cystoprostatectomy may be indicated in some patients who have a small capacity fibrotic bladder or intractable voiding symptoms related to radiation cystitis. Good long-term results can be expected in this patient group; however, exenterative surgery in patients with locally advanced disease is associated with comparably inferior results and should not be advocated. If cystectomy is necessary, orthotopic urinary diversion can be performed safely in young motivated patients who wish to maintain a better quality of life with associated morbidity. Although the higher rate of incontinence and impotence after salvage procedures may detract from the quality of life, the impact of these long-term complications on the patient's overall well-being is less than previously believed, and most patients are satisfied with their treatment outcome and adjust well to the circumstances, accepting some increased degree of morbidity. This observation emphasizes the value of careful preoperative counseling and the discussion of treatment options and outcomes, which also should incorporate quality of life issues.