Prostate cancer is a leading malignancy affecting men globally and in Canada. Biochemical recurrence (BCR), marked by rising prostate-specific antigen (PSA) levels post-curative-intended local treatment, is prevalent in nearly one-third of prostate cancer patients and is associated with increased risk of metastases and mortality. The management of patients with BCR is evolving rapidly, highlighting the need for practical guidance. This review aims to provide guidance to clinicians on the use and subsequent implications of advanced imaging results in patients with BCR. In addition, current management approaches, including salvage therapies post-radical prostatectomy, as well as the integration of androgen deprivation therapy (ADT) plus androgen receptor pathway inhibitors (ARPI), are explored.