while for others the cup will be half empty (unknown benefit,significant chance of requiring additional surgery to main-tain QOL). However, at least we now have better informa-tion to balance upon the decision scale.

The future usefulness of salvage prostatectomy lies inanswering both of these questions more completely. Withless morbid treatments, such as salvage prostate cryoabla-tion, the final unanswered question will bring us full circlequestioning in whom cure is really necessary.

John F. WardUniversity of Texas

M. D. Anderson Cancer CenterHouston, Texas

1. Freiha, F. S. and Bagshaw, M. A.: Carcinoma of the prostate:results of post-irradiation biopsy. Prostate, 5: 19, 1984

2. Holzman, M., Carlton, C. E., Jr. and Scardino, P. T.: The fre-quency and morbidity of local tumor recurrence after defin-itive radiotherapy for stage C prostate cancer. J Urol, 146:1578, 1991

3. Scardino, P. T. and Wheeler, T. M.: Local control of prostatecancer with radiotherapy: frequency and prognostic signifi-

cance of positive results of postirradiation prostate biopsy.NCI Monogr, 7: 95, 1988

4. Coen, J. J., Zietman, A. L., Thakral, H. and Shipley, W. U.:Radical radiation for localized prostate cancer: local persis-tence of disease results in a late wave of metastases. J ClinOncol, 20: 3199, 2002

REPLY BY AUTHORS

What is known is that the vast majority of patients with abiopsy proven prostate cancer recurrence and an increasingPSA 1 year or more after completion of definitive radiationtherapy will have either local progression, metastatic dis-ease or die of cancer by year 8. Few of these patients do wellwith conservative management. What remains unknown iswhether any salvage therapy can alter this course. We re-ported our experience with salvage prostatectomy in thesepatients in terms of control, recurrence-free survival and thesequelae of the operation. Patients and their physiciansneed to make an educated decision regarding active or pas-sive therapy when faced with this problem and a greateramount of information can only aid this process.

SALVAGE RADICAL PROSTATECTOMY2032