Most men with prostate cancer in the United States are treated with either surgery or radiation. Unfortunately, not all men will be cured of there cancer with this initial treatment. Therefore, some patients can benefit from salvage therapy; treatment of residual or recurrent cancer.
If the recurrence (or residual disease) is in a distant metastatic site, drug therapy (also known as systemic therapy) is necessary so that all sites of spread throughout the body are targeted. If the cancer recurs in the area around the prostate (the prostatic fossa), then salvage local therapy may be indicated. This means that a patient who had surgery may benefit from radiation to clean up residual cancer cells. Conversely, if initial radiation treatment did not eradicate all of the cancer in the prostate, that patient may need to surgery to remove the prostate and the residual cancer. This is known as a salvage prostatectomy.
In a certain percentage of patients, prostate cancer can return after attempted cure with radiation. If a man experiences a recurrence of prostate cancer limited to the prostate, then he may be candidate for a salvage prostatectomy.
- This can be performed as an open or robotic (or laparoscopic) surgical radical prostatectomy (in which the prostate, the adjoining seminal vesicles, and the surrounding lymph nodes are removed) or through cryotherapy (freezing; in which just the prostate is targeted).
- Because of scarring from the radiation, salvage prostatectomy is more difficult than traditional (initial or de novo) prostate surgery or cryotherapy. Consequently, side effects from treatment are more common. These primarily involve bladder and sexual dysfunction.
- Every attempt is made to spare the nerves that enable sexual function, although this is quite difficult during a salvage prostatectomy. Therefore, these patients are candidates for interposition nerve grafting.