The goal of primary radiation therapy in the treatment of prostate cancer is to eradicate all of the local tumor. Although patients with relapsing disease after radiation therapy differ in their risk of death from prostate cancer, many will develop local progression, metastasis, and death. The recognition that local recurrence after radiation therapy portends a poor prognosis has led to the development of improved methods for early detection of recurrence and the development of alternative treatment strategies for radioresistant cancers. This article reviews knowledge regarding radiation failure and the role of salvage radical prostatectomy for men with local recurrence after radiation therapy for prostate cancer.