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Managing Prostate Cancer Biochemical Recurrence after Definitive Local Therapy.

Joshua Winograd¹, Evan Suzman¹, Shu Wang¹

¹Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY 10065, USA.

The Urologic Clinics of North America

|April 15, 2026

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Biochemical recurrence of prostate cancer is a varied condition. Advanced imaging like prostate-specific membrane antigen (PSMA) PET helps identify recurrence type, guiding treatment from observation to therapies.

Area of Science:

Oncology
Radiology
Urology

Background:

Prostate cancer recurrence presents diverse clinical states, from indolent to aggressive metastatic disease.
Standard definitions of biochemical recurrence involve prostate-specific antigen (PSA) levels post-treatment.
Accurate risk stratification is crucial for effective management.

Purpose of the Study:

To review definitions and risk stratification of prostate cancer recurrence.
To highlight the role of advanced imaging, specifically PSMA PET.
To discuss current and emerging management strategies.

Main Methods:

Literature review of definitions, risk stratification tools, and imaging modalities.
Analysis of the clinical utility of PSA doubling time, Gleason grade, and pathology.

Keywords:

Androgen deprivation therapy Biochemical recurrence Metastasis-direct therapy Metastatic disease Prostate cancer Prostate-specific antigen Radiation Radical prostatectomy

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Evaluation of prostate-specific membrane antigen (PSMA) PET in distinguishing recurrence patterns.

Main Results:

Biochemical recurrence definitions are based on PSA thresholds post-surgery or radiation.
Risk stratification incorporates clinical, pathological, and imaging data.
PSMA PET imaging is pivotal in differentiating local from systemic recurrence.

Conclusions:

Understanding recurrence heterogeneity is key to personalized treatment.
PSMA PET enhances the accuracy of recurrence detection and staging.
Management strategies are tailored based on recurrence characteristics, ranging from watchful waiting to advanced therapies.