Is there evidence that prostatectomy improves overall survival in local recurrence of prostate cancer post-definitive radiation?  

I am not aware of any prospective clinical trial data to suggest that salvage prostatectomy for locally recurrent prostate cancer improves overall survival as compared to any other comparator. Such evidence would be very difficult to generate given that historically, most prospective studies have fo...

Agree with Dr. @Patel's excellent response. There is very limited data out there for all the reasons above (difficult surgery, morbidity, etc). One series with a review of 3 older series Eastham et al., PMID 12756084 (n=106) showing ~50% moderate to severe incontinence and ~10% potency.&nb...

If you re-stage the patient with a PSMA PET CT and there is only a focal area of activity in the prostate gland, then I think you have a good case for seed-implant salvage therapy.