Managing Prostate Cancer Biochemical Recurrence after Definitive Local Therapy

Biochemical recurrence of prostate cancer represents a heterogeneous clinical state ranging from indolent disease to aggressive metastatic progression. Standard definitions include a prostate-specific antigen (PSA) 0.2 ng/mL or greater post-prostatectomy or a rise of 2 ng/mL above nadir following radiation therapy. Risk stratification incorporating PSA doubling time, Gleason grade, surgical pathology, and advanced imaging, particularly prostate-specific membrane antigen (PSMA) PET, guides clinical decision-making by distinguishing local from systemic recurrence. This review highlights definitions, risk stratification, the role of PSMA PET imaging, and management strategies ranging from observation to local salvage, systemic therapy, and emerging metastasis-directed approaches.