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Aaron Katz, MD, FACS, Chairman of Urology at Winthrop University Hospital and Professor of Urology at NYU Long Island School of Medicine, discusses the ins and outs of various salvage therapies for the treatment of patients that have failed primary radiation treatment. He begins by discussing different methods of patient selection for salvage therapy, including differentiation of isolated local recurrence versus systemic spread, patient age, and comorbidities, as well as the proper steps in conducting thorough patient history and workup. Next, Dr. Katz reviews several non-curative and potentially curative salvage therapy options and discusses the impact these therapies have on relative quality of life, in addition to their relative 5 and 10-year biochemical free survival rates. He concludes with a patient case study along with data from numerous single and multi-institution studies that demonstrate the relative quality of life impacts as well as relative 5 and 10-year disease-specific survival rates for these salvage procedures.