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

Video content above is prompted by the following:

1. 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)
2. Role of the multidisciplinary care team in patient management
3. Practical considerations: tumor volume, PSA/PSA doubling time
4. 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)
5. 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?