(UroToday.com) The 2026 European Association of Urology (EAU) annual meeting featured a plenary prostate cancer session and a presentation by Dr. Ursula Vogl discussing the optimal management of oligorecurrent disease, and that systemic therapy should be used for oligorecurrent lesions. Dr. Vogl’s discussion was based on a prior case presentation of a 61-year-old fit man with oligo-recurrent prostate cancer after radical prostatectomy, with a PSA of 1.5 ng/mL (PSA doubling time: 3 months) and 3 PSMA-positive pelvic lymph node metastases.
She started her presentation by noting that it is not too late for systemic therapy, but yes indeed, this patient needs systemic therapy. Based on this patient’s characteristics, tumor characteristics, and first biochemical recurrence characteristics, he has a high-risk biochemical recurrence and is cN1 based on PSMA PET/CT, thus he has non-metastatic hormone-sensitive prostate cancer after primary therapy. Moreover, his PSA is 1.5 ng/mL and his PSA doubling time is 3 months, undoubtedly making him high risk. Dr. Vogl emphasized that systemic treatment will positively impact his metastasis-free and overall survival.
This patient is an EMBARK1 patient and should have a discussion around enzalutamide + ADT in an intermittent fashion:
Furthermore, this patient is also a STAMPEDE2 patient and would be a candidate for long term ADT + 2 years of abiraterone + prednisone:
Even if opting for a PEACE V/STORM trial3-like approach, systemic therapy is part of the concept of this phase 2 trial:
Dr. Vogl suggests that a personalized approach with maximum intensification may be reasonable, and although there is no data, it may make sense considering only moderate additional toxicity. This may include treatment according to EMBARK or STAMPEDE (ADT + androgen receptor pathway inhibitor) + stereotactic body radiotherapy to the PSMA PET-positive lymph nodes +/- the pelvis.
Dr. Vogl concluded her presentation discussing the optimal management of oligorecurrent disease and that systemic therapy should be used for oligorecurrent lesions with the following take-home points:
- In patients with high-risk biochemical recurrence/non-metastatic hormone-sensitive prostate cancer with EMBARK criteria, we need to initiate androgen receptor pathway inhibitor (enzalutamide) + ADT (intermittent concept)
- In recurrent clinical N1 non-metastatic hormone-sensitive prostate cancer, we can consider treatment according to STAMPEDE with 3 years of ADT + 2 years of abiraterone + prednisone
- We should discuss personalized additional local treatment to positive lymph nodes in a multidisciplinary tumor board setting
Presented by: Ursula Vogl, MD, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2026 European Association of Urology (EAU) Annual Meeting, London, United Kingdom, Fri, Mar 13 – Mon, Mar 16, 2026.
References:
- Freedland SJ, de Almeida Luz M, De Giorgi U, et al. Improved Outcomes with Enzalutamide in Biochemically Recurrent Prostate Cancer. N Engl J Med 2023 Oct 19;389(16):1453-1465.
- Attard G, Murphy L, Clarke NW, et al. Abiraterone acetate and prednisolone with or without enzalutamide for high-risk non-metastatic prostate cancer: A meta-analysis of primary results from two randomized controlled phase 3 trials of the STAMPEDE platform protocol. Lancet 2022 Jan 29;399(10323):447-460.
- Ost P, Siva S, Brabrand S, et al. Salvage metastasis-directed therapy versus elective nodal radiotherapy for oligorecurrent nodal prostate cancer metastases (PEACE V-STORM): A phase 2, open-label, randomized controlled trial. Lancet Oncol. 2025 Jun;26(6):695-706.