Salvage radical prostatectomy in the management of locally recurrent prostate cancer after 125I implantation

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Abstract
Objective To define the role of salvage prostatectomy in patients who have locally recurrent prostate cancer following pelvic lymph node dissection and 125 implantation. Patients and methods Over 1000 patients underwent 125I implantation for localized prostate cancer at the Memorial Sloan Kettering Cancer Center between 1970 and 1986. Salvage radical prostatectomy was performed in a highly selected group of 10 patients with locally recurrent disease. Results Three of the 10 patients had organ‐confined residual prostate cancer following salvage radical prostatectomy. The remaining seven patients had extra‐prostatic disease including four patients with positive surgical margins. Two patients with organ‐confined disease and one with extracapsular tumour had no evidence of locally recurrent or metastatic disease and continue to have undetectable prostate‐specific antigen (PSA) levels at 50, 44, and 31 months following salvage radical prostatectomy. After a mean follow‐up of 30 months, the remaining seven patients had a rising PSA level consistent with locally persistent and/or metastatic disease (median 5 ng/mL; range 1.0–144). This PSA elevation occurred within 20 months of salvage radical prostatectomy (median 6 months). Two of these patients developed clinically evident bone metastases. Conclusion Salvage radical prostatectomy, although technically feasible in highly selected patients, should not be widely advocated as an effective treatment option for patients with locally recurrent prostate cancer after 125 implantation.