Salvage surgery for locally recurrent prostate cancer after radiation therapy: Tricks of the trade

Biochemical recurrence after either radical prostatectomy or radiation therapy of prostate cancer will develop in an estimated 50,000 U.S. men. Salvage therapy has the potential of curing an isolated local recurrence of prostate cancer, however, this comes at the cost of potential morbidity. Salvage surgery after primary radiotherapy is technically demanding, and surgical expertise is necessary to optimize treatment outcomes while minimizing the inherent risks of the operation. Over the last decade, we have developed a substantial experience in salvage surgery for locally recurrent prostate cancer, and have developed key technical points and innovations that include primary closure of the bladder neck, bladder augmentation, and catheterizable urinary reconstruction using a Monti or Mitrofanoff procedure as a method of reducing the risks of postoperative urinary incontinence. We hope this review will provide the surgical oncologist and urologist with the important considerations that must be considered in salvage surgery. In addition, we discuss the importance and surgical details of using a well-vascularized rectus flap as a method of reducing perioperative morbidity.