Managing Biochemical Recurrence in Prostate Cancer: Risk Stratification and Treatment Decisions

Author(s):

Joeseph Renzulli, MD,Ganesh V. Raj, MD, PhD

Key Takeaways

Management options for nmCSPC include active surveillance, radiotherapy, surgery, and systemic therapy, guided by NCCN recommendations.
High-volume symptomatic patients with minimal comorbidities may benefit from triplet therapy, including docetaxel, darolutamide, and androgen deprivation therapy.
Multidisciplinary care teams are essential in managing nmCSPC, considering tumor volume and PSA dynamics.
Biochemical recurrence with a PSA doubling time under 12 months indicates high risk for rapid progression, requiring timely intervention.

Panelists discuss how management options for nonmetastatic castration-sensitive prostate cancer (nmCSPC) include active surveillance, radiotherapy, and systemic therapy, with recommendations influenced by factors such as tumor volume, prostate-specific antigen (PSA) doubling time, and patient life expectancy, particularly for those with high-volume symptomatic disease.

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EP: 1.Emerging Trends and Rising Prevalence of mCSPC

EP: 2.Defining mCSPC: Diagnostic Criteria, Imaging Approaches, and Patient Identification

EP: 3.Overcoming Unmet Needs in Treating mCSPC: ADT Monotherapy vs Multimodal Approaches

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Video content above is prompted by the following:

What management options are available for nmCSPC? What factors influence whether you recommend active surveillance vs active treatment?
1. National Comprehensive Cancer Network (NCCN) recommendations (active surveillance, radiotherapy, surgery, systemic therapy) (NCCN, Prostate Cancer, v4.2024; Moreira et al, Cancer Manag Res, 2021)
2. Patients with high-volume symptomatic disease, without significant comorbidities, and long life expectancy could receive triplet therapy ofdocetaxel, darolutamide, and androgen deprivation therapy (ARASENS trial: Hussain et al, J Clin Oncol, 2023; PEACE-1 trial: Bossi et al. J Clin Oncol, 2023)
Role of the multidisciplinary care team in patient management
Practical considerations: tumor volume, PSA/PSA doubling time
Biochemical recurrence (BCR): PSA doubling time less than 12 months considered at high risk for rapid disease progression and death (Markowski et al, Clin Gen Cancer, 2019)
Treatment considerations in trying to delay progression, 30% with BCR will develop metastatic disease (Antonarakis et al, BJU Int, 2012)
1. How can progression to metastatic disease be delayed?