***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Despite improvements in treatment of localized prostate cancer , local recurrence remains a significant problem . A total of 46 patients with proven local cancer recurrence following external beam radiotherapy entered a prospect i ve clinical trial using ultrasound-guided cryosurgery to ablate the residual prostate gl and . Persistent complications included one urethra – rectal fistula , incontinence ( 2 ) , retention ( 3 ) , and treatment induced erectile dysfunction ( 7 ) . Using the PSA definitions for biochemical failure as PSA ⩾0.3 ng/ml , the Kaplan – Meier plots showed the incidence of patients to be free of biochemical recurrence at 51 and 44 % at 1 and 2 y , respectively . For a PSA ⩾1.0 , the values at 1 and 2 y were 72 and 58 % PURPOSE Few patients with locally recurrent prostate cancer after external beam ( EB ) or interstitial ( I ) radiotherapy ( RT )  are considered c and i date s for salvage radical prostatectomy ( RP ) due to high reported rates of major complications and urinary incontinence . We report the morbidity associated with salvage RP in 100 consecutive patients . MATERIAL S AND METHODS From 1984 to 2003 salvage RP was performed for recurrent prostate cancer following EBRT in 58 cases , and IRT in 42 ( 28 retropubic ) and ( 14 transperineal ) . Clinical information was obtained from a prospect i ve data base . RESULTS Since 1993 , the major complication rate has decreased significantly ( 13 % vs 33 % , p = 0.02 ) , including the rectal injury rate ( 2 % vs 15 % , p = 0.01 ) . Compared with retropubic IRT and /or pre-radiotherapy pelvic lymph node dissection the risk of major complications following EBRT or transperineal IRT was significantly less ( OR 0.2 , p = 0.006 ) . At 5 years an estimated 39 % of patients were dry and 68 % required 1 pad daily or less . A total of 23 patients with moderate-severe incontinence underwent artificial sphincter placement . The anastomotic stricture rate was 30 % . The 5-year potency rate was 28 % following unilateral or bilateral nerve sparing RP and 45 % in previously potent patients . CONCLUSIONS Due to patient selection the major complication rate after salvage RP has improved significantly with time and it is similar to that of st and ard RP . Rates of anastomotic stricture and moderate to severe incontinence are higher than those observed after st and ard RP . However , most patients recover reasonable urinary continence and a substantial number of select patients recover potency . The acceptable morbidity profile of salvage RP following EBRT and transperineal IRT should persuade more physicians to consider patients for this potentially curative procedure Objectives In this study , we evaluate the outcomes of salvage cryotherapy for locally recurrent prostate cancer within the COLD ( cryo online data ) Registry . Furthermore , we assess the results of salvage cryotherapy ( with intermediate follow-up ) stratified by pre-treatment prostate-specific antigen ( PSA ) levels to determine which patients may best be suited for treatment . Methods The COLD registry was developed as a prospect i ve , central ly collected data base among patients undergoing salvage cryoablation for locally recurrent prostate cancer following primary prostate radiotherapy with curative intent . Of the patients undergoing salvage cryotherapy ( without neoadjuvant hormonal ablative therapy ) , complete medical records were available in 156 patients , with their mean follow-up being 3.8 years ( 0.9–12.7 years ) . The treatment outcomes of salvage cryotherapy were assessed using the Phoenix definition ( nadir PSA + 2 ng/ml ) of biochemical failure . Results Of our entire study population , the biochemical disease-free survival ( bDFS ) rates at 1 , 2 , and 3 years were 89.0 , 73.7 , and 66.7 % , respectively . Stratification of our patients into two subgroups is based on their pre-treatment total serum PSA values < 5 and ≥5 ng/ml , and bDFS rates at 3 years for these two subgroups were 78.3 and 52.9 % , respectively . A Kaplan – Meier analysis of bDFS stratified by these same pre-treatment PSA values revealed that the subset of patients with a PSA ≥ 5 ng/ml had statistically significant poorer bDFS rates ( P = 0.01 ) . Conclusions Salvage prostate cryotherapy is a potentially curative local salvage therapy . The importance of early referral when patients have a pre-treatment PSA < 5 ng/ml is essential to optimize treatment outcomes The authors prospect ively evaluated the late gastrointestinal ( GI ) and genitourinary ( GU ) toxicity and prostate‐specific antigen ( PSA ) control of magnetic resonance imaging (MRI)‐guided brachytherapy used as salvage for radiation therapy ( RT ) failure PURPOSE Radiation Therapy Oncology Group protocol 85 - 31 was design ed to evaluate the effectiveness of adjuvant and rogen suppression , using goserelin , in unfavorable prognosis carcinoma of the prostate treated with definitive radiotherapy ( RT ) . METHODS AND MATERIAL S Eligible patients were those with palpable primary tumor extending beyond the prostate ( clinical Stage T3 ) or those with regional lymphatic involvement . Patients who had undergone prostatectomy were eligible if penetration through the prostatic capsule to the margin of resection and /or seminal vesicle involvement was documented histologically . Stratification was based on histologic differentiation , nodal status , acid phosphatase status , and prior prostatectomy . The patients were r and omized to either RT and adjuvant goserelin ( Arm I ) or RT alone followed by observation and application of goserelin at relapse ( Arm II ) . In Arm I , the drug was to be started during the last week of RT and was to be continued indefinitely or until signs of progression . RESULTS Between 1987 and 1992 , when the study was closed , 977 patients were entered : 488 to Arm I and 489 to Arm II . As of July 2003 , the median follow-up for all patients was 7.6 years and for living patients was 11 years . At 10 years , the absolute survival rate was significantly greater for the adjuvant arm than for the control arm : 49 % vs. 39 % , respectively ( p = 0.002 ) . The 10-year local failure rate for the adjuvant arm was 23 % vs. 38 % for the control arm ( p < 0.0001 ) . The corresponding 10-year rates for the incidence of distant metastases and disease-specific mortality was 24 % vs. 39 % ( p < 0.001 ) and 16 % vs. 22 % ( p = 0.0052 ) , respectively , both in favor of the adjuvant arm . CONCLUSION In a population of patients with unfavorable prognosis carcinoma of the prostate , and rogen suppression applied as an adjuvant after definitive RT was associated not only with a reduction in disease progression but in a statistically significant improvement in absolute survival . The improvement in survival appeared preferentially in patients with a Gleason score of 7 - 10 PURPOSE A positive post-irradiation prostatic biopsy associated with an increasing prostate specific antigen level but no palpable evidence of local progression may identify a subgroup of patients who could be cured by salvage  surgical therapy .  MATERIAL S AND METHODS Between 1967 and 1992 , 132 patients underwent salvage surgery , including radical retropubic prostatectomy in 79 , anterior exenteration in 38 , total exenteration in 5 and bilateral pelvic lymphadenectomy only in 10 .  RESULTS The 10-year cancer-specific survival rate in the prostatectomy group was 72 % . Local control was equivalent among the surgical groups . Radical retropubic prostatectomy patients with negative surgical margins and nonaneuploid tumors demonstrated a significant survival advantage . Adjuvant hormonal therapy improved the disease-free survival rate in patients with nonaneuploid tumors . CONCLUSIONS Radical retropubic prostatectomy can achieve excellent survival with low morbidity in select patients . Patients with clinical stage T2 or less disease and with prostate specific antigen detected cancers ( 52 % and 75 % , respectively ) had pathological stage T2 disease . Thus , by using modern diagnostic techniques patients can be identified who may be cured with salvage surgery PURPOSE We review our 20-year experience with  salvage radical prostatectomy  to determine prognostic variables predictive of oncological control of radiorecurrent prostate cancer . Using a st and ardized question naire we also evaluate outcome data regarding the long-term sexual and urinary effects of salvage radical prostatectomy . MATERIAL S AND METHODS Between 1983 and 2002 salvage radical prostatectomy was performed in 51 patients with locally recurrent prostate cancer following definitive radiotherapy .  Clinical information was obtained from a prospect i ve data base . Quality of life data were collected using the UCLA Prostate Cancer Index , a vali date d , patient administered instrument . RESULTS At 5 years 47 % of patients were progression-free without and rogen deprivation therapy . Among patients with pT2 disease 100 % were progression-free at 5 years , compared with 35 % of patients with pT3N0 disease or higher and 0 % of patients with node positive ( pTxN+ ) disease ( p < 0.001 ) . Preoperative PSA 5.0 ng/ml or less was predictive of organ confined disease , and strongly associated with prolonged progression-free and overall survival ( p < 0.001 and 0.01 , respectively ) . Mean urinary function scores for patients with or without an artificial urinary sphincter compared favorably with scores reported after st and ard , nonsalvage prostatectomy .  Sexual dysfunction was nearly uniform in patients undergoing st and ard salvage radical prostatectomy but implantation of a penile prosthesis was associated with a clinical ly significant improvement in sexual function . CONCLUSIONS When initiated early in the course of recurrent disease , salvage radical prostatectomy provides excellent oncological control of radiorecurrent prostate cancer without the need for and rogen ablation . Implantation of an artificial urinary sphincter and inflatable penile prosthesis devices in patients with postoperative urinary incontinence or erectile dysfunction results in significantly improved quality of life parameters INTRODUCTION Prostate cancer recurrence following primary radiation is common . If the recurrence remains localized to the prostate gl and , 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 identified all patients undergoing salvage prostatectomy at the Vancouver General Hospital between 1995 and 2010 from a prospect ively recorded and maintained prostate cancer data base . 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 prospect ively and confirmed by retrospective chart review . RESULTS Over a 15-year period , salvage prostatectomy was successfully completed in 21 patients . With a median follow-up period of 68 months ( range : 2 - 122 ) , 9 ( 43 % ) patients experienced a biochemical recurrence , with most failing within the first 2 years of surgery . There were 3 deaths in the cohort , all from prostate cancer , giving a prostate cancer specific and overall survival of 86 % . The main postoperative morbidity was bladder neck contracture , occurring in 40 % . One patient each developed a recto-urethral fistula 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 first Canadian centre to report that salvage prostatectomy can be performed with favourable oncological and functional outcomes PURPOSE Salvage radical prostatectomy is associated with a higher complication rate than radical prostatectomy without prior radiotherapy but the magnitude of the increase is not well delineated . MATERIAL S AND METHODS A total of 3,458 consecutive patients underwent open radical prostatectomy and 98 underwent open salvage radical prostatectomy from January 1999 to June 2007 . Data were collected from prospect i ve surgical and institutional morbidity data bases , and retrospectively from billing records and medical records . Medical and surgical complications were captured , grade d by the modified Clavien classification and classified by time of onset . RESULTS Median followup after salvage radical prostatectomy and radical prostatectomy was 34.5 and 45.5 months , respectively . Patients with salvage had significantly higher median age , modified Charlson comorbidity score , clinical and pathological stage , and Gleason score . They were less likely to have organ confined disease and more likely to have seminal vesicle invasion and nodal metastasis . There was no significant difference in median operative time , blood loss or transfusion rate . The salvage group had a higher adjusted probability of medical and surgical complications , including urinary tract infection , bladder neck contracture , urinary retention , urinary fistula , abscess and rectal injury . Only 
    Output:
    
Meta-regression adjusting for confounders found no significant difference in oncologic outcomes between SRP and nonsurgical salvage modalities .
SBT , SCT , and SHIFU appeared to have better continence outcomes than SRP .
Oncologic outcomes are comparable for SRP and all three nonsurgical salvage modalities .
We found no significant differences in toxicity outcomes among modalities ; however , SRP appears to be associated with worse rates of urinary incontinence than SBT , SCT , and SHIFU .
Oncologic and toxicity outcomes appear to be similar ; however , all nonsurgical salvage modalities may be associated with better continence outcomes