(UroToday.com) The American Urological Association (AUA) 2025 Annual Meeting, held in Las Vegas, NV, was host to The International Prostate Forum. Dr. R. Jonathan Henderson provided a focused, high-level overview highlighting key points for the management of biochemically recurrent prostate cancer patients in 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
- Low-risk biochemical recurrence: Observation may be considered
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:
- Risk stratify each patient
- Consider a patient’s estimated life expectancy
- Shared decision making between patients and physicians is critical
- Consider clinical trial enrolment, where available
Presented by: R. Jonathan Henderson, MD, Arkansas Urology, Little Rock, AR
Written by: Rashid K. Sayyid, MD, MSc – Robotic Urologic Oncology Fellow at The University of Southern California, @rksayyid on Twitter during the 2025 American Urological Association (AUA) annual meeting held in Las Vegas, NV, Saturday, April 26 - Tuesday, April 29, 2025