Salvage prostatectomy (sRP) is one of several treatment options for localized prostate cancer recurrence after radiation. However, given the complexity of this operation, traditionally high complication rates, and poor functional outcomes, sRP has historically been underutilized. Herein, we aim to review the indications, outcomes, and technical advancements of sRP in modern practice.
A literature review was performed using PubMed, Google Scholar, and Scopus for relevant articles that were synthesized in the current work.
Improvements in interpretation of magnetic resonance imaging and increased adoption of molecular imaging can better detect local and oligometastatic recurrence. In combination with clinical variables, this can better select patients who may achieve a durable response from sRP. Ten-year biochemical recurrence-free survival after sRP ranges from 28 to 53%, with cancer specific survival ranging from 65 to 83%. While complication rates for sRP are higher than for primary prostatectomy, major complications, especially rectal injury, have decreased significantly. Erectile function is poor after sRP, although most studies report high rates of pre-operative impotence. Continence rates are highly variable (20-80%) secondary to heterogeneous reporting. Due to high rates of lymph node involvement, lymph node dissection should be performed with sRP and has prognostic value. Finally, robotic sRP is gaining popularity and may lead to improvements in continence, although further study is needed.
Salvage prostatectomy can achieve durable cancer control in a substantial group of patients. With improving complication rates and functional outcomes in experienced hands, sRP remains an important treatment for radio-recurrent prostate cancer.
World journal of urology. 2026 Jun 09*** epublish ***
Matthew S Lee, R Jeffrey Karnes
Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA., Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. .