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Biochemical recurrence of prostate cancer is a rising PSA after surgery or radiotherapy with nothing yet visible on scans. Salvage radiotherapy can still cure it after surgery, and for a fast-doubling PSA the EMBARK trial showed that enzalutamide with or without hormone therapy delays spread.
Biochemical recurrence is defined as a PSA of 0.2 ng/mL or more, confirmed, after radical prostatectomy, or a rise of 2 ng/mL above the nadir after radiotherapy (the Phoenix definition). It is found by routine PSA follow-up; PSMA PET now locates the recurrence in most men once PSA passes about 0.5 ng/mL, and often shows disease that conventional imaging misses. After prostatectomy, early salvage radiotherapy to the prostate bed, started before PSA reaches 0.5, cures many men, with short-term hormone therapy added for higher-risk features. After radiotherapy, local salvage by surgery, brachytherapy, cryotherapy or high-intensity focused ultrasound is possible for confirmed local recurrence. Men with a PSA doubling time under nine months are at high risk of metastasis: EMBARK randomised 1,068 such men and showed enzalutamide with leuprolide, or enzalutamide alone, cut metastasis or death by about half compared with leuprolide alone, and the FDA approved enzalutamide for this setting in 2023. Slowly rising PSA can be watched, and PSMA PET-directed stereotactic radiotherapy to a few metastases is under study.
A rising PSA follows a quarter to a third of prostatectomies and radiotherapy courses; only a minority of these men develop metastases on scans within ten years, and the PSA doubling time tells the two apart.
About three quarters of cancers arise in the peripheral zone at the back of the gland, the part a finger or a biopsy needle reaches; drainage is to the obturator and iliac nodes.
Same organ: Prostate cancer, Ductal adenocarcinoma of the prostate, Localised prostate cancer, very low and low risk, Localised prostate cancer, intermediate risk, Localised prostate cancer, high and very high risk, Metastatic hormone-sensitive prostate cancer, Non-metastatic castration-resistant prostate cancer, Metastatic castration-resistant prostate cancer, Neuroendocrine and small-cell prostate cancer
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Also on OnCo: Symptoms and red flags · Early detection roadmap.
Early salvage radiotherapy to the prostate bed, with or without pelvic nodes and four to six months of androgen deprivation for adverse features; observation for slow doubling times.
Salvage prostatectomy, brachytherapy, cryotherapy or high-intensity focused ultrasound in fit men with biopsy-proven local disease and no metastases on PSMA PET.
Enzalutamide with leuprolide, or enzalutamide alone (EMBARK); PSMA PET before starting; intermittent therapy with treatment suspension when PSA becomes undetectable.
Stereotactic radiotherapy to the visible metastases, usually within trials or with hormone therapy; the survival benefit is unproven.
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Enzalutamide, with or without androgen deprivation, is now approved for high-risk biochemical recurrence, and intermittent therapy with treatment suspension is built into the regimen.
PSMA PET-CT is the preferred staging investigation for high-risk prostate cancer and for biochemical recurrence, though most treatment trials were designed with conventional imaging.
Observation with early salvage radiotherapy at PSA recurrence is standard after prostatectomy, avoiding radiotherapy in most men who would never have needed it.
Query for this cancer: (TITLE:"Biochemical recurrence of prostate cancer" OR ABSTRACT:"Biochemical recurrence of prostate cancer" OR TITLE:"Biochemically recurrent prostate cancer" OR ABSTRACT:"Biochemically recurrent prostate cancer" OR TITLE:"PSA recurrence" OR ABSTRACT:"PSA recurrence" OR TITLE:"Rising PSA after local therapy" OR ABSTRACT:"Rising PSA after local therapy" OR TITLE:"nmHSPC" OR ABSTRACT:"nmHSPC" OR TITLE:"Hormone-relapsed prostate cancer, PSA-only" OR ABSTRACT:"Hormone-relapsed prostate cancer, PSA-only") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Biochemical recurrence of prostate cancer, not a curated reading list.
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See all on the product pages:EnzalutamideLeuprolide (leuprorelin) and GnRH agonists·Printable cards in the navigator
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