Therapy of Treatment Failure After Curative Treatment of Prostate Cancer

Objective: Recurrence rates of 40–60% after percutaneous radiotherapy or brachytherapy and 20–40% after prostatectomy are described. This review will discuss curative treatment options for salvage after primary therapy. Methods: Relevant information was identified through searches of published studies, abstracts from scientific meetings, and review articles. Results: Clinical experience in salvage therapy is limited. Salvage prostatectomy is an effective method to treat selected patients with recurrence after percutaneous radiotherapy. Cryoablation and brachytherapy are alternative methods. Conformal radiotherapy to the prostatic bed for PSA relapse and biopsy proven local recurrences after prostatectomy remains the only potentially curative therapy. It can provide durable biochemical control in a range from 17% to 78%. Salvage radiotherapy is well tolerated. Some prognostic factors exist which can help to select the right patient for this treatment. Patients have to be treated early for PSA relapse. Conclusions: Salvage prostatectomy for highly selected patients is an effective treatment with excellent long-term control. Complication rates were reduced in the last years. Conformal radiotherapy to the prostatic bed for PSA relapse and biopsy proven local recurrences after prostatectomy is a good documented curative therapy. In a patient with a high probability of local recurrence early radiotherapy for PSA relapse is suggested. # 2006 European Association of Urology and European Board of Urology. Published by Elsevier B.V. All rights reserved.