Most men treated for localised prostate cancer remain free of the disease. For some, however, cancer returns in the prostate after radiotherapy, HIFU or another focal treatment. In selected men, removing the prostate at this stage can offer another chance of cure. This is called salvage robotic prostatectomy.
What "salvage" means
In cancer care, salvage treatment is treatment given after a first treatment has not fully controlled the disease. A salvage prostatectomy removes the prostate when cancer has returned, or persisted, after a non-surgical treatment that aimed to cure it.
How recurrence is found
Recurrence is usually first suspected because PSA starts to rise. Our guide to what your PSA should do after treatment explains how this is defined.
To find out whether the cancer is in the prostate or elsewhere, your team may recommend:
- an MRI scan of the prostate
- a PSMA PET scan, to look for spread beyond the prostate
- a biopsy of the prostate, to confirm the cancer and its grade
Salvage surgery is only considered when the cancer appears to be limited to the prostate. Our article on combining MRI and PSMA PET scans explains these tests.
Who may be suitable
Salvage surgery is not suitable for everyone, and careful selection is essential. It may be considered for men who:
- have cancer that is confined to the prostate
- have no evidence of spread to lymph nodes or other areas, or only limited nodal disease in selected cases
- are fit for surgery
- have a reasonable life expectancy
- understand the higher risk of side effects
Why salvage surgery is more complex
Previous treatment changes the tissues around the prostate:
- After radiotherapy: the tissues become scarred and have a reduced blood supply, which makes separating the prostate from the bladder and rectum more difficult and healing slower.
- After HIFU or focal therapy: scar tissue may form in the treated area, although the effects are often less extensive than after radiotherapy.
The magnified view and precise instruments of robotic surgery can help, but these operations are technically demanding and should be carried out by experienced surgeons. Our guide to focal therapy and HIFU explains those treatments.
Risks compared with first-time surgery
Compared with a first prostatectomy, salvage surgery has higher risks of:
- urinary leakage, which may be more severe and longer lasting
- erection problems, as nerve-sparing is often not possible
- narrowing at the join between the bladder and urethra
- injury to the rectum, although this remains uncommon in experienced hands
- a longer catheter time
Some men need further procedures for continence after salvage surgery, such as an artificial urinary sphincter or a male sling. These can be very effective, and knowing they are available can help men weigh up the decision.
Other options
Salvage surgery is one of several possible treatments for recurrence in the prostate. Others include:
- salvage focal therapy, such as HIFU or cryotherapy
- salvage brachytherapy, in selected cases
- hormone therapy. Our guide to hormone therapy explains how it works.
- careful monitoring, for slowly rising PSA
The right choice depends on the first treatment, where the cancer is, your health and your priorities. Your case should be discussed by a multidisciplinary team that has experience of treating recurrent disease. NICE guidance on prostate cancer covers the management of recurrence.
Questions to ask
- Is the cancer confined to the prostate?
- How many salvage operations have you performed?
- What are the likely effects on continence and erections for me?
- What other options do I have?
Prostate Cancer UK has information about treatment when cancer comes back.
Professor Prokar Dasgupta assesses men with recurrent prostate cancer for salvage surgery at The London Clinic. Please contact the clinic to arrange a consultation.