Early release. Published at www.cuaj.ca on January 24, 2012. Subject to revision. © 2012 Canadian Urological Association Can Urol Assoc J 1 Cite as: Can Urol Assoc J 2012. http://dx.doi.org/10.5489/cuaj.11056. Epub 24 Jan 2012. Abstract Introduction: Prostate cancer recurrence following primary radia- tion is common. If the recurrence remains localized to the prostate gland, surgical removal may result in long-term local control or cure. Despite the well-established oncological outcomes, salvage prostatectomy is infrequently performed or reported. We present our experience with salvage prostatectomy at a Canadian centre. Methods: We identiied all patients undergoing salvage prosta- tectomy at the Vancouver General Hospital between 1995 and 2010 from a prospectively recorded and maintained prostate can- cer database. Details regarding initial presentation, delivery of radiotherapy, clinical features at the time of recurrence, as well as oncological and functional outcomes, were collected. Information regarding postoperative morbidity was collected prospectively and conirmed by retrospective chart review. Results: Over a 15-year period, salvage prostatectomy was success- fully completed in 21 patients. With a median follow-up period of 68 months (range: 2-122), 9 (43%) patients experienced a biochem- ical recurrence, with most failing within the irst 2 years of surgery. There were 3 deaths in the cohort, all from prostate cancer, giving a prostate cancer speciic and overall survival of 86%. The main postoperative morbidity was bladder neck contracture, occurring in 40%. One patient each developed a recto-urethral istula and osteitis pubis. Physician-recorded data regarding continence was available in 13 (62%). Of these 13 patients, 10 (85%) men were recorded as dry or using 1 pad per day. Conclusions: This is the irst Canadian centre to report that salvage prostatectomy can be performed with favourable oncological and functional outcomes. Introduction Radiation therapy (RT), either in the form of external beam radiotherapy (EBRT) or brachytherapy, is commonly used to treat localized prostate cancer. Recent analysis of the CaPSURE database indicates that up to 25% of men present- ing in North America choose some form of radiotherapy as their primary treatment. 1 Similar to other treatment modali- ties, the risk of disease recurrence is directly related to the extent and grade of disease at presentation, with up to 10% of low-risk patients and up to 60% of high-risk patients expe- riencing disease recurrence in the medium- to long-term. 2 Several therapeutic options exist to manage locally recur- rent prostate cancer post-irradiation, including active surveil- lance, androgen deprivation therapy (ADT), thermotherapy or cryotherapy, salvage brachytherapy and radical prosta- tectomy. The last three modalities have been reported to be curative in selected patients, although a number of series report that successful salvage rates are higher with surgery than either cryotherapy or brachytherapy. 3-5 Although tumour recurrence post-radiotherapy is common, and in more than 70% is localized to the prostate gland, salvage prostatectomy in infrequently performed. In a survey of clinicians’ treat- ment recommendations for biochemical recurrence post- radiotherapy, only 25% considered salvage prostatectomy the preferred option in patients younger than 65, which fell to 4% in patients over this age. 6 Lack of enthusiasm for prosta- tectomy as a salvage option probably relects concerns about the technical dificulties associated with the procedure, as well as higher postoperative morbidity. In the last decade, there have been a number of con- temporary series describing the oncological and functional outcomes of salvage prostatectomy, with very reasonable results reported. 5,7,8 However, most these reports represent the experience of the three high-volume cancer centres in the United States, and therefore the results may not accurate- ly relect those of smaller or non-American centres. In par- ticular, the local results of Canadian centres are unknown. We report our 15-year experience with salvage radical pros- tatectomy at the Vancouver General Hospital (Vancouver, BC, Canada). Niall M. Corcoran, MD, PhD; * Guilherme Godoy, MD; * Rodney C. Studd, MD; * Rowan G. Casey, MD; * Antonio Hurtado-Coll, MD; * Scott Tyldesley, MD, FRCPC; † S. Larry Goldenberg, MD, FRCSC, FACS; * Martin E. Gleave, MD, FRCSC, FACS * * Department of Urological Sciences and Vancouver Prostate Centre, University of British Columbia, Vancouver, BC; † Department of Radiation Oncology, BC Cancer Agency, Vancouver, BC Salvage prostatectomy post-deinitive radiation therapy: The Vancouver experience ORIGINAL RESEARCH