Prostate Cancer: Management of Biochemical Recurrence after Surgery

• Elena Moreno-Olmedo ^[1] ; Vladimir Suárez-Gironzini ^[1] ; Juan Pablo Fusco ^[2] ; Lucrecia Ruiz ^[2] ; José Begara ^[3] ; Marcos Guijarro ^[1] ; Carmen González San Segundo ^[4] ; Juan Zafra ^[5] ; Fernando López Campos ^[6] ; Felipe Couñago ^[1]
  1. [1] Department of Radiation Oncology, GenesisCare, Madrid
  2. [2] Department of Medical Oncology, Genesiscare, Madrid
  3. [3] Department of Radiation Oncology, GenesisCare, Malaga
  4. [4] Department of Radiation Oncology, Gregorio Marañón Universitary Hospital, Madrid
  5. [5] Department of Radiation Oncology, Virgen de la Victoria Hospital, Malaga
  6. [6] Department of Radiation Oncology, Ramon y Cajal Universitary Hospital, Madrid

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• Localización: Archivos españoles de urología, ISSN 0004-0614, Tomo 76, Nº. 10, 2023, págs. 733-745
• Idioma: inglés
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• Resumen

  • Radical prostatectomy (RP) is one of the primary treatment options for localised prostate cancer (PCa). Despite its curative intent, 1/3 of patients will experience biochemical recurrence (BCR) during follow-up. Experts have devoted efforts to associate the influence of each individual factor with the risk of BCR to select the optimal treatment for each patient. Optimal management must aim to find a balance between delaying the onset of metastatic disease and overtreating an indolent disease with treatments that can affect quality of life of the patients. Thus far, effective treatment options for men with BCR remain controversial in terms of ideal treatment timing (adjuvant vs. salvage), radiotherapy (RT) fields and doses, selection and duration of systemic therapy and potential synergies between treatments and their therapeutic sequencing. Next-generation imaging techniques, such as Prostate-Specific Membrane Antigen Positron Emission Tomography, are used for early detection of disease progression and exact site of recurrence or progression, thereby enhancing decision making for future disease management. In this review, we evaluate available evidence of controversial topics regarding BCR after RP and explore future directions, such as prognostic and/or predictive factors of response, genetic panels, second-generation hormone treatments, ultra-hypofractionated RT and ongoing clinical trials in this clinical scenario.