Salvage radiotherapy for locally recurrent prostate cancer after primary radiation is generally performed using brachytherapy. Only a limited amount of small studies has been performed so far. In these studies the rate of severe toxicity, requiring operative reinterven-tion, was high and cancer control outcome was disappointing. Furthermore, it is unclear whether salvage treatment will improve dis-ease-specific or overall survival. For these reasons, salvage brachytherapy is not popular and usually only performed in large tertiary centers. Salvage can currently be considered in patients with a pathology-proven local recurrence with an interval of at least 2–3 years after primary treatment, together with a limited and nonaggressive tumor presentation at time of salvage. Currently, experienced groups recommend at least equal doses used in primary treatment, together with targeting the entire prostate. Diagnostic developments in magnetic resonance imaging (MRI) and positron emission tomography (PET) and biopsy techniques such as transperineal and MRI-targeted biopsies provide the possibility to localize the macroscopic recurrent tumor in the prostate. This enables a shift to focal salvage techniques which can be expected to reduce severe toxicity rates while maintaining cancer control.