We present oncologic outcomes, complications, and patient satisfaction for a series of men who elected for salvage robotic-assisted radical prostatectomy (sRARP) at our tertiary referral center. We reviewed a prospective database of consecutive patients who underwent sRARP from 2004-2021 following detection of failed primary non-surgical treatment for prostate cancer (PC). Clinicopathologic data and 90-day Clavien-Dindo complications were recorded. Continence, no pad use or single security liner, and potency, erection sufficient for penetration with or without oral pharmacotherapy, were assessed. The Kaplan-Meier method was used to estimate prostate-specific antigen (PSA) free survival (PSAFS), i.e. post-operative PSA ≥0.2 ng/mL, and overall survival (OS). Cox regression analyses were performed to identify factors associated with PSAFS. Lastly, we queried three of eight Likert-type items (scored 1 to 5) from the validated surgical satisfaction questionnaire 8 (SSQ-8) to evaluate patient satisfaction. Seventy-eight men with a median age of 67 (IQR 63-71) years and preoperative PSA of 3.7 (IQR 2.4-5.8) ng/mL underwent sRARP. Final pathology identified ≥pT3N0M0 and positive margins in 35 (45%) and 23 (29%) patients, respectively. Median follow-up was 10.1 (IQR 5.8-12.4) years. Continence and potency were maintained in 33/62 (53%) and 1/16 (6%) men, respectively. The total and major (≥ grade III) complication rates were 39 (50%) and 26 (33%), respectively; the most common complication was anastomotic stricture in 17 (32%) patients. Eleven (14%) patients had post-operative PSA ≥0.2 ng/mL. The estimated 3-, 5-, and 10-year PSAFS and OS were 86.9 and 97.4%, 82.5 and 94.5%, 72.6 and 83.3%, respectively. On multivariable analysis pre-operative PSA, Gleason score 8-10, and histopathologic extracapsular extension were significantly associated with PSAFS (Table 1). SSQ-8 responses were highly in favor of sRARP (Table 2). sRARP remains a technically challenging and morbid treatment modality that can be curative for select men after failed non-surgical primary treatment for PC. Most patients do not voice regret with their decision to pursue sRARP despite the risk of complications and change in genitourinary function postoperatively. [ABSTRACT FROM AUTHOR]