Managing High-Risk Biochemical Recurrence in Advanced Prostate Cancer

In “Managing High-Risk Biochemical Recurrence in Advanced Prostate Cancer,” our panel explores the evolving treatment landscape for patients experiencing biochemical recurrence following definitive therapy. Through the case of a 75-year-old man with a rising PSA after radical prostatectomy, a rapid PSA doubling time, and multiple cardiovascular and metabolic comorbidities, the expert faculty discuss how risk stratification and patient-specific factors influence treatment selection.

The panel reviews key considerations in the management of high-risk biochemical recurrence, including PSA kinetics, conventional and advanced imaging, and the potential role of metastasis-directed therapy. Faculty discuss the challenges of balancing treatment efficacy with tolerability in patients with significant comorbidities and examine how emerging evidence is shaping decisions regarding treatment intensification.

Expert faculty review findings from the EMBARK trial, including the role of enzalutamide alone or in combination with androgen deprivation therapy, and discuss how these data have established new treatment options for patients with high-risk biochemical recurrence. The panel also explores lessons from the PRESTO study and the ongoing ARASTEP trial, highlighting how these studies are expanding understanding of earlier intervention strategies across the advanced prostate cancer continuum. Throughout the discussion, panelists emphasize individualized decision-making, careful interpretation of imaging findings, and the importance of considering both disease biology and patient fitness when selecting therapy. The episode highlights how advances in risk assessment and treatment intensification are reshaping care for patients with advanced prostate cancer following biochemical recurrence

Our next episode, “Treatment Intensification in Metastatic Castration-Sensitive Prostate Cancer,” features the panelists discussing how patient fitness, disease burden, and treatment goals influence decisions regarding doublet and triplet therapy. The panel also explores the evolving role of chemotherapy, ARPI selection, and emerging real-world evidence supporting treatment intensification strategies in mCSPC.