Salvage local therapy

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Salvage radical prostatectomy is well known to be a morbid procedure, with high incontinence and impotence rates. Salvage radiation therapy may also add morbidity to radical prostatectomy. Impotence is generally the rule, but continence is often preserved if XRT is delivered after enough time has passed for the patient to regain postoperative continence. However, rigorous study of salvage treatments using validated instruments is extremely limited. Tefilli etal.69 used the FACT-G and FACT-P instruments to study their series of patients with locally recurrent prostate cancer who underwent salvage prostatectomy versus salvage XRT. As one would expect, salvage prostatectomy was associated with significantly lower scores for physical well-being, and urinary continence compared to salvage XRT.

Perrotte et al.70 studied the MD Anderson series of salvage cryotherapy using a modified UCLA PCI and SF36, and AUASI. They were able to demonstrate significantly better incontinence and pain scores with a urethral warmer catheter compared to no warming catheter, and higher impotence with a double freeze-thaw cycle. Overall satisfaction rates were 33%, and they saw no significant advantage over salvage prostatectomy.

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