Tumor Types: M0 progression prostate cancer

AUA 2025

Dr. Henderson noted that prostate cancer remains the 2nd most frequently diagnosed cancer annually in men, accounting for 7.3% of all incident tumors worldwide. Following primary therapy, approximately 30% of men will experience biochemical recurrence, and >30% will be found to have metastases at the time of biochemical recurrence.

How is biochemical recurrence defined? Various PSA cut-offs have been defined, based on the primary therapy received:

Post-radical prostatectomy: Rising PSA >0.2 ng/ml
- PSA persistence: Failure of PSA to decline below 0.1 ng/ml following a radical prostatectomy
Post-external beam radiotherapy: A PSA rise >2 ng/ml above nadir

While current guidelines lack consensus regarding the optimal management of biochemically recurrent prostate cancer patients, they all agree on the following key principles:

Consider a patient’s life expectancy
Risk stratifying patients is critical

Low-risk biochemical recurrence: Observation may be considered
- EAU definition: PSA doubling time (PSADT) >1 year and presence of pathologic Grade Group <4 disease on the radical prostatectomy specimen
High-risk biochemical recurrence: Timely salvage treatment should be considered

EAU definition: PSADT <1 year or presence of pathologic Grade Group 4–5 disease on the radical prostatectomy specimen

For patients with high-risk biochemical recurrence, Dr. Henderson highlighted the following treatment options:
- External beam radiotherapy (EBRT) +/- ADT
- ADT +/- non-steroidal anti-androgen (NSAA)
  - Continuous or intermittent
- Salvage radical prostatectomy in select, fit patients with prostatic fossa-limited disease
- High-intensity focused ultrasound (HIFU)
- Cryotherapy
Dr. Henderson concluded his presentation with the following take home messages for the management of biochemically recurrent prostate cancer patients: