A valid treatment option for recurrence after definite radiotherapy (RT) for localized prostate cancer (PC) is salvage radical prostatectomy (SRP). However, data on SRP are scarce, possibly resulting in an underutilization. A systematic review was performed using MEDLINE (Pubmed), Embase, and Web of Science databases including studies published between January 1980 and April 2020. Overall, 23 English language articles including a total number of 2323 patients were selected according to PRISMA criteria. The overall median follow-up was 37.5 months (IQR 35.5-52.5). Biochemical-recurrence (BCR)-free probability ranged from 34% to 83% at five years, respectively, and from 31% to 37% at 10 years. Cancer specific survival (CSS) and overall survival (OS) ranged from 88.7% to 98% and 64% to 95% at five years and from 72% to 83% and 65% to 72% at 10 years, respectively. Positive surgical margins ranged from 14% to 45.8% and pathologic organ-confined disease was reported from 20% to 57%. The rate of pathologic > T2-disease ranged from 37% to 80% and pN1 disease differed between 0% to 78.4%. Pre-SRP PSA, pre-SRP Gleason Score (GS), pathologic stage after SRP, and pathologic lymph node involvement seemed to be the strongest prognostic factors for good outcomes. SRP provides accurate histopathological and functional outcomes, as well as durable cancer control. Careful patient counseling in a shared decision-making process is recommended.

Department of Urology 2nd Faculty of Medicine Charles University 150 06 Prague Czech Republic

Department of Urology and Division of Experimental Oncology URI Urological Research Institute IRCCS San Raffaele Scientific Institute 20132 Milan Italy

Department of Urology and Division of Medical Oncology Weill Medical College of Cornell University New York NY 10065 USA

Department of Urology King Fahad Specialist Hospital Dammam 32253 Saudi Arabia

Department of Urology Medical University of Vienna 1090 Vienna Austria

Department of Urology The Jikei University School of Medicine Tokyo 105 8461 Japan

Department of Urology University Hospital Cologne 50923 Cologne Germany

Department of Urology University Hospital Hamburg Eppendorf 20251 Hamburg Germany

Department of Urology University of Texas Southwestern Dallas TX 75390 USA

Division of Urology Department of Special Surgery Jordan University Hospital The University of Jordan Amman 11942 Jordan

Institute for Urology and Reproductive Health 1 M Sechenov 1st Moscow State Medical University 119992 Moscow Russia

Karl Landsteiner Institute of Urology and Andrology 3100 St Pölten Austria

See more in PubMed

Cornford P., Bellmunt J., Bolla M., Briers E., Santis M.D., Gross T., Henry A.M., Joniau S., Lam T.B., Mason M.D., et al. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part II: Treatment of Relapsing, Metastatic, and Castration-Resistant Prostate Cancer. Eur. Urol. 2017;71:630–642. doi: 10.1016/j.eururo.2016.08.002. PubMed DOI

Agarwal P.K., Sadetsky N., Konety B.R., Resnick M.I., Carroll P.R. (CaPSURE) C of the PSURE. Treatment failure after primary and salvage therapy for prostate cancer: Likelihood, patterns of care, and outcomes. Cancer. 2008;112:307–314. doi: 10.1002/cncr.23161. PubMed DOI

Shariat S.F., Kattan M.W., Vickers A.J., Karakiewicz P.I., Scardino P.T. Critical review of prostate cancer predictive tools. Future Oncol. 2009;5:1555–1584. doi: 10.2217/fon.09.121. PubMed DOI PMC

Walz J., Gallina A., Perrotte P., Jeldres C., Trinh Q.-D., Hutterer G.C., Traumann M., Ramírez A., Shariat S.F., McCormack M., et al. Clinicians are poor raters of life-expectancy before radical prostatectomy or definitive radiotherapy for localized prostate cancer. BJU Int. 2007;100:1254–1258. doi: 10.1111/j.1464-410X.2007.07130.x. PubMed DOI

Chade D.C., Shariat S.F., Cronin A.M., Savage C.J., Karnes R.J., Blute M.L., Briganti A., Montorsi F., van der Poel H.G., Van Poppel H., et al. Salvage Radical Prostatectomy for Radiation-recurrent Prostate Cancer: A Multi-institutional Collaboration. Eur. Urol. 2011;60:205–210. doi: 10.1016/j.eururo.2011.03.011. PubMed DOI PMC

Heidenreich A., Richter S., Thüer D., Pfister D. Prognostic Parameters, Complications, and Oncologic and Functional Outcome of Salvage Radical Prostatectomy for Locally Recurrent Prostate Cancer after 21st-Century Radiotherapy. Eur. Urol. 2010;57:437–445. doi: 10.1016/j.eururo.2009.02.041. PubMed DOI

Gotto G.T., Yunis L.H., Vora K., Eastham J.A., Scardino P.T., Rabbani F. Impact of Prior Prostate Radiation on Complications After Radical Prostatectomy. J. Urol. 2010;184:136–142. doi: 10.1016/j.juro.2010.03.031. PubMed DOI

Moschini M., Zaffuto E., Karakiewicz P., Mattei A., Gandaglia G., Fossati N., Montorsi F., Briganti A., Shariat S.F. The effect of androgen deprivation treatment on subsequent risk of bladder cancer diagnosis in male patients treated for prostate cancer. World J. Urol. 2018;37:1127–1135. doi: 10.1007/s00345-018-2504-3. PubMed DOI

Gandaglia G., Sun M., Popa I., Schiffmann J., Trudeau V., Shariat S.F., Trinh Q.-D., Graefen M., Widmer H., Saad F., et al. Cardiovascular Mortality in Patients With Metastatic Prostate Cancer Exposed to Androgen Deprivation Therapy: A Population-Based Study. Clin. Genitourin. Cancer. 2015;13:e123–e130. doi: 10.1016/j.clgc.2014.12.003. PubMed DOI

Kluth L.A., Shariat S.F., Kratzik C., Tagawa S., Sonpavde G., Rieken M., Scherr D., Pummer K. The hypothalamic–pituitary–gonadal axis and prostate cancer: Implications for androgen deprivation therapy. World J. Urol. 2013;32:669–676. doi: 10.1007/s00345-013-1157-5. PubMed DOI

Chade D.C., Eastham J., Graefen M., Hu J.C., Karnes R.J., Klotz L., Montorsi F., van Poppel H., Scardino P.T., Shariat S.F. Cancer Control and Functional Outcomes of Salvage Radical Prostatectomy for Radiation-recurrent Prostate Cancer: A Systematic Review of the Literature. Eur. Urol. 2012;61:961–971. doi: 10.1016/j.eururo.2012.01.022. PubMed DOI

Onol F.F., Bhat S., Moschovas M., Rogers T., Ganapathi H., Roof S., Rocco B., Patel V. Comparison of outcomes of salvage robot-assisted laparoscopic prostatectomy for post-primary radiation vs focal therapy. BJU Int. 2020;125:103. doi: 10.1111/bju.14900. PubMed DOI

Jansen B.H., van Leeuwen P.J., Wondergem M., van der Sluis T.M., Nieuwenhuijzen J.A., Knol R.J., van Moorselaar R.J., van der Poel H.G., Oprea-Lager D.-E., Vis A.N. Detection of Recurrent Prostate Cancer Using Prostate-specific Membrane Antigen Positron Emission Tomography in Patients not Meeting the Phoenix Criteria for Biochemical Recurrence After Curative Radiotherapy. Eur. Urol. Oncol. 2020 doi: 10.1016/j.euo.2020.01.002. in press. PubMed DOI

Grubmüller B., Baltzer P., D’Andrea D., Korn S., Haug A., Hacker M., Grubmüller K.H., Goldner G.M., Wadsak W., Pfaff S., et al. 68Ga-PSMA 11 ligand PET imaging in patients with biochemical recurrence after radical prostatectomy–diagnostic performance and impact on therapeutic decision-making. Eur. J. Nucl. Med. Mol. Imaging. 2017;49:1374–1378. doi: 10.1007/s00259-017-3858-2. PubMed DOI PMC

Mohler J.L., Antonarakis E.S., Armstrong A.J., D’Amico A.V., Davis B.J., Dorff T., Eastham J.A., Enke C.A., Farrington T.A., Higano C.S., et al. Prostate Cancer, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology. JNCCN. 2019;17:479–505. doi: 10.6004/jnccn.2019.0023. PubMed DOI

Liberati A., Altman D.G., Tetzlaff J., Mulrow C., Gøtzsche P.C., Ioannidis J.P.A., Clarke M., Devereaux P.J., Kleijnen J., Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. J. Clin. Epidemiol. 2009;62:e1-34. doi: 10.1016/j.jclinepi.2009.06.006. PubMed DOI

Metcalfe M.J., Troncoso P., Guo C.C., Chen H.-C., Bozkurt Y., Ward J.F., Pisters L.L. Salvage prostatectomy for post-radiation adenocarcinoma with treatment effect: Pathological and oncological outcomes. Can. Urol. Assoc. J. 2017;11:E277–E284. doi: 10.5489/cuaj.4304. PubMed DOI PMC

Kenney P.A., Nawaf C.B., Mustafa M., Wen S., Wszolek M.F., Pettaway C.A., Ward J., Davis J.W., Pisters L.L. Robotic-assisted laparoscopic versus open salvage radical prostatectomy following radiotherapy. Can. J. Urol. 2016;23:8271–8277. PubMed PMC

Mandel P., Steuber T., Ahyai S., Kriegmair M., Schiffmann J., Boehm K., Heinzer H., Michl U., Schlomm T., Haese A., et al. Salvage radical prostatectomy for recurrent prostate cancer: Verification of European Association of Urology guideline criteria. BJU Int. 2015;117:55–61. doi: 10.1111/bju.13103. PubMed DOI

Bates A.S., Samavedi S., Kumar A., Mouraviev V., Rocco B., Coelho R., Palmer K., Patel V.R. Salvage robot assisted radical prostatectomy: A propensity matched study of perioperative, oncological and functional outcomes. European journal of surgical oncology. EJSO. 2015;41:1540–1546. doi: 10.1016/j.ejso.2015.06.002. PubMed DOI

Yuh B., Ruel N., Muldrew S., Mejia R., Novara G., Kawachi M., Wilson T. Complications and outcomes of salvage robot-assisted radical prostatectomy: A single-institution experience. BJU Int. 2014;113:769–776. doi: 10.1111/bju.12595. PubMed DOI

Meeks J.J., Walker M., Bernstein M., Eastham J.A. Seminal vesicle involvement at salvage radical prostatectomy. BJU Int. 2013;111:E342–E347. doi: 10.1111/bju.12034. PubMed DOI

Gorin M.A., Manoharan M., Shah G., Eldefrawy A., Soloway M.S. Urological Oncology Salvage open radical prostatectomy after failed radiation therapy: A single center experience. Cent. Eur. J. Urol. 2011;64:144–147. doi: 10.5173/ceju.2011.03.art9. PubMed DOI PMC

Eandi J.A., Link B.A., Nelson R.A., Josephson D.Y., Lau C., Kawachi M.H., Wilson T.G. Robotic Assisted Laparoscopic Salvage Prostatectomy for Radiation Resistant Prostate Cancer. J. Urol. 2010;183:133–137. doi: 10.1016/j.juro.2009.08.134. PubMed DOI

Pisters L.L., Leibovici D., Blute M., Zincke H., Sebo T.J., Slezak J.M., Izawa J., Ward J., Scott S.M., Madsen L., et al. Locally Recurrent Prostate Cancer After Initial Radiation Therapy: A Comparison of Salvage Radical Prostatectomy Versus Cryotherapy. J. Urol. 2009;182:517–527. doi: 10.1016/j.juro.2009.04.006. PubMed DOI

Leonardo C., Simone G., Papalia R., Franco G., Guaglianone S., Gallucci M. Salvage radical prostatectomy for recurrent prostate cancer after radiation therapy. Int. J. Urol. Off. J. Jpn. Urol. Assoc. 2009;16:584–586. doi: 10.1111/j.1442-2042.2008.02209.x. PubMed DOI

Paparel P., Cronin A.M., Savage C., Scardino P.T., Eastham J.A. Oncologic Outcome and Patterns of Recurrence after Salvage Radical Prostatectomy. Eur. Urol. 2009;55:404–410. doi: 10.1016/j.eururo.2008.07.007. PubMed DOI

Sanderson K.M., Penson D., Cai J., Groshen S., Stein J.P., Lieskovsky G., Skinner D.G. Salvage Radical Prostatectomy: Quality of Life Outcomes and Long-Term Oncological Control of Radiorecurrent Prostate Cancer. J. Urol. 2006;176:2025–2032. doi: 10.1016/j.juro.2006.07.075. PubMed DOI

Amling C.L., E Lerner S., Martin S.K., Slezak J.M., Blute M.L., Zincke H. Deoxyribonucleic acid ploidy and serum prostate specific antigen predict outcome following salvage prostatectomy for radiation refractory prostate cancer. J. Urol. 1999;161:857–862. doi: 10.1016/S0022-5347(01)61790-7. PubMed DOI

Tefilli M.V., Gheiler E.L., Tiguert R., Banerjee M., Forman J., Pontes J., Wood D.P. Salvage surgery or salvage radiotherapy for locally recurrent prostate cancer. Urology. 1998;52:224–229. doi: 10.1016/S0090-4295(98)00151-4. PubMed DOI

E Lerner S., Blute M.L., Zincke H. Critical evaluation of salvage surgery for radio-recurrent/resistant prostate cancer. J. Urol. 1995;154:1103–1109. doi: 10.1016/S0022-5347(01)66988-X. PubMed DOI

Rogers E., Ohori M., Kassabian V.S., Wheeler T.M., Scardino P.T. Salvage Radical Prostatectomy. J. Urol. 1995;153:104–110. doi: 10.1097/00005392-199501000-00037. PubMed DOI

Zincke H. Radical Prostatectomy and Exenterative Procedures for Local Failure after Radiotherapy with Curative Intent: Comparison of Outcomes. J. Urol. 1992;147:894–899. doi: 10.1016/S0022-5347(17)37415-3. PubMed DOI

Rainwater L.M., Zincke H. Radical Prostatectomy After Radiation Therapy for Cancer of the Prostate: Feasibility and Prognosis. J. Urol. 1988;140:1455–1459. doi: 10.1016/S0022-5347(17)42072-6. PubMed DOI

Vartolomei M.D., D’Andrea D., Chade D.C., Soria F., Kimura S., Foerster B., Abufaraj M., Mathieu R., Moschini M., Rouprêt M., et al. Role of serum cholinesterase in patients treated with salvage radical prostatectomy. Urol. Oncol. Semin. Orig. Invest. 2019;37:123–129. doi: 10.1016/j.urolonc.2018.11.013. PubMed DOI

Pearce S.M., Richards K., Patel S.G., Pariser J., Eggener S.E. Population-based analysis of salvage radical prostatectomy with examination of factors associated with adverse perioperative outcomes. Urol. Oncol. Semin. Orig. Invest. 2015;33:163.e1–163.e6. doi: 10.1016/j.urolonc.2015.01.016. PubMed DOI

Bianco F.J., Scardino P.T., Stephenson A.J., Diblasio C.J., Fearn P.A., Eastham J.A. Long-term oncologic results of salvage radical prostatectomy for locally recurrent prostate cancer after radiotherapy. Int. J. Radiat. Oncol. 2005;62:448–453. doi: 10.1016/j.ijrobp.2004.09.049. PubMed DOI

Rouvière O., Vitry T., Lyonnet D. Imaging of prostate cancer local recurrences: Why and how? Eur. Radiol. 2010;20:1254–1266. doi: 10.1007/s00330-009-1647-4. PubMed DOI

Luiting H.B., Van Leeuwen P.J., Busstra M.B., Brabander T., Van Der Poel H.G., Donswijk M., Vis A.N., Emmett L., Stricker P.D., Roobol M.J. Use of gallium-68 prostate-specific membrane antigen positron-emission tomography for detecting lymph node metastases in primary and recurrent prostate cancer and location of recurrence after radical prostatectomy: An overview of the current literature. BJU Int. 2019;125:206–214. doi: 10.1111/bju.14944. PubMed DOI PMC

Oehus A.-K., Kroeze S.G.C., Schmidt-Hegemann N.-S., Vogel M.M.E., Kirste S., Becker J., Burger I.A., Derlin T., Bartenstein P., Eiber M., et al. Efficacy of PSMA ligand PET-based radiotherapy for recurrent prostate cancer after radical prostatectomy and salvage radiotherapy. BMC Cancer. 2020;20:362–369. doi: 10.1186/s12885-020-06883-5. PubMed DOI PMC

Ingrosso G., Becherini C., Lancia A., Caini S., Ost P., Francolini G., Høyer M., Bottero M., Bossi A., Zilli T., et al. Nonsurgical Salvage Local Therapies for Radiorecurrent Prostate Cancer: A Systematic Review and Meta-analysis. Eur. Urol. Oncol. 2020;3:183–197. doi: 10.1016/j.euo.2018.12.011. PubMed DOI

Marra G., Karnes R.J., Calleris G., Oderda M., Alessio P., Palazzetti A., Battaglia A., Pisano F., Munegato S., Munoz F., et al. Oncological outcomes of salvage radical prostatectomy for recurrent prostate cancer in the contemporary era: A multicenter retrospective study. Urol. Oncol. Semin. Orig. Invest. 2021;39:296.e21–296.e29. doi: 10.1016/S2666-1683(20)33404-2. PubMed DOI

Alibhai S.M., Gogov S., Allibhai Z. Long-term side effects of androgen deprivation therapy in men with non-metastatic prostate cancer: A systematic literature review. Crit. Rev. Oncol. 2006;60:201–215. doi: 10.1016/j.critrevonc.2006.06.006. PubMed DOI

Philippou Y., Parker R.A., Volanis D., Gnanapragasam V.J. Comparative Oncologic and Toxicity Outcomes of Salvage Radical Prostatectomy Versus Nonsurgical Therapies for Radiorecurrent Prostate Cancer: A Meta–Regression Analysis. Eur. Urol. Focus. 2016;2:158–171. doi: 10.1016/j.euf.2015.09.004. PubMed DOI

Valle L.F., Lehrer E.J., Markovic D., Elashoff D., Levin-Epstein R., Karnes R.J., Reiter R.E., Rettig M., Calais J., Nickols N.G., et al. A Systematic Review and Meta-analysis of Local Salvage Therapies After Radiotherapy for Prostate Cancer (MASTER) Eur. Urol. 2020 doi: 10.1016/j.eururo.2020.11.010. in press. PubMed DOI PMC

Duchesne G.M., Woo H.H., Bassett J.K., Bowe S., D’Este C., Frydenberg M., King M., Ledwich L., Loblaw A., Malone S., et al. Timing of androgen-deprivation therapy in patients with prostate cancer with a rising PSA (TROG 03.06 and VCOG PR 01-03 [TOAD]): A randomised, multicentre, non-blinded, phase 3 trial. Lancet Oncol. 2016;17:727–737. doi: 10.1016/S1470-2045(16)00107-8. PubMed DOI

Payne H., Khan A., Chowdhury S., Davda R. Hormone therapy for radiorecurrent prostate cancer. World J. Urol. 2012;31:1333–1338. doi: 10.1007/s00345-012-0952-8. PubMed DOI

Siddiqui S.A., Boorjian S.A., Inman B., Bagniewski S., Bergstralh E.J., Blute M.L. Timing of Androgen Deprivation Therapy and its Impact on Survival After Radical Prostatectomy: A Matched Cohort Study. J. Urol. 2008;179:1830–1837. doi: 10.1016/j.juro.2008.01.022. discussion 1837. PubMed DOI

Boorjian S.A., Thompson R.H., Tollefson M.K., Rangel L.J., Bergstralh E.J., Blute M.L., Karnes R.J. Long-Term Risk of Clinical Progression After Biochemical Recurrence Following Radical Prostatectomy: The Impact of Time from Surgery to Recurrence. Eur. Urol. 2011;59:893–899. doi: 10.1016/j.eururo.2011.02.026. PubMed DOI

Brassetti A., Bollens R. Laparoscopic radical prostatectomy in 2018: 20 years of worldwide experiences, experimentations, researches and refinements. Minerva Chir. 2019;74:37–53. doi: 10.23736/S0026-4733.18.07740-4. PubMed DOI

Klotz L. Active surveillance for prostate cancer: For whom? J. Clin. Oncol. 2005;23:8165–8169. doi: 10.1200/JCO.2005.03.3134. PubMed DOI

Fossati N., Willemse P.-P.M., den Broeck T.V., van den Bergh R.C.N., Yuan C.Y., Briers E., Bellmunt J., Bolla M., Cornford P., Santis M.D., et al. The Benefits and Harms of Different Extents of Lymph Node Dissection During Radical Prostatectomy for Prostate Cancer: A Systematic Review. Eur. Urol. 2017;72:84–109. doi: 10.1016/j.eururo.2016.12.003. PubMed DOI

Impact of persistent PSA after salvage radical prostatectomy: a multicenter study