External beam radiation salvage for residual or recurrent local tumor following radical prostatectomy

External beam radiation therapy was used as a means of salvage in 32 patients with either incomplete excision or palpable local recurrence following radical prostatectomy. Patients were divided into 2 groups consisting of 13 patients who were referred within 4 months of incomplete excision (group 1) and 19 who were referred only after palpable local recurrence had developed (group 2). The 5 and 10-year actuarial survival free of disease in group 1 was 57 per cent, compared to 40 and 20 per cent for group 2 (p equals 0.05). Fourteen patients with an elevated pre-radiation therapy serum acid phosphatase level and/or bladder invasion had an especially poor prognosis, with a median survival free of disease of only 2.4 years. Ten complications were recorded in 5 patients (16 per cent), which were slightly higher than experienced in irradiated patients without a previous radical operation. The data support the contention that external beam radiation therapy may offer a means of post-radical prostatectomy salvage for selected patients with incomplete excision or palpable local recurrence. The best results were obtained in patients who were referred within 4 months of prostatectomy because of incomplete excision rather than waiting for palpable local recurrence to develop.