Today, we do not have a consensus yet, on the treatment of prostate cancer recurrences after definitive radiation therapy. Differentiation of local recurrences from metastasis is the most significant problem encountered in radiation treated prostate cancer cases. Although positive prostate biopsy has several limitations it is accepted to be the only method for confirming local recurrences. In general, classical imaging techniques do not have any contribution on diagnosis when PSA levels are below 10 ng/ml. However new imaging methods like positron emission tomography can be more effective in the future for the detection of recurrences at lower PSA levels. Relapses in prostate cancer can be classified as local, distant or biochemical relapses. It is of interest that although treatment of local relapses are usually in a curative manner whereas biochemical relapses are usually treated with androgen blockade in a non-curative manner which has gained wide acceptance as the standard of care in this setting. Initial presentation, PSA-related derivatives, patients' expectancies and current status are important features in consideration of treatment planning. In recent years, radical prostatectomy cryotherapy, brachytherapy and high-intensity focused ultrasound are the preferred treatment options for local relapses of prostate cancer after definitive radiotherapy. On the other hand androgen deprivation therapy, photodynamic therapy, and observation are the less preferred methods in this setting. All available methods have their own complication and success rates. Available data we have today is still immature and suffer from short follow-up periods. Thus we are far away to suggest a gold standard treatment for prostate cancer recurrences after definitive radiation therapy.