Salvage Oligometastasectomy and Radiation Therapy in Recurrent Prostate Cancer

Inclusion Criteria: * Histologically proven adenocarcinoma of the prostate. * Recurrent prostate carcinoma after definitive therapy for primary disease defined as: * Post-prostatectomy (with/without adjuvant radiotherapy): Patients must have a detectable or rising PSA level that is \> 0.05 ng/mL, with a second confirmatory level of \> 0.05 ng/mL after a minimum of 1 week. * Post radiotherapy/ablation (without radical prostatectomy): PSA rise \>= 2ng/mL over nadir. * Subjects treated with prior definitive radiotherapy for prostate cancer who have positive molecular imaging (e.g., fluciclovine PET/CT scan or other per PI discretion) suggesting recurrent intraprostatic disease must undergo transrectal ultrasound (TRUS) biopsy less than or equal to one year before study enrollment: * If the TRUS biopsy is negative, no additional treatment is required to the prostate in addition to that of scan positive sites. * If the TRUS biopsy is positive, subject must undergo salvage prostatectomy or salvage radiotherapy to the primary site concurrently with the study treatment per the treatment protocol algorithm. * NOTE: Biopsy is not required for prostate fossa recurrences after radical prostatectomy. * Oligometastatic disease defined as 10 or fewer metastatic lesions to lymph nodes and/or bones only. * For patients with oligometastatic disease involving lymph nodes, metastasis is confined to the pelvic or para-aortic (below IMA) regions on molecular imaging (e.g., fluciclovin…