Longoni Mattia, Falkenbach Fabian, Graefen Markus, Maurer Tobias, Karakiewicz Pierre I, Montorsi Francesco, Briganti Alberto, Gandaglia Giorgio
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele.
Curr Opin Urol. 2025 Sep 1;35(5):510-516. doi: 10.1097/MOU.0000000000001292. Epub 2025 May 2.
This review explores challenges in managing biochemical recurrence (BCR) after radical prostatectomy and postoperative radiotherapy for prostate cancer (PCa) highlighting gaps in risk stratification, imaging, and emerging therapies, as well as advances in molecular imaging and personalized treatment.
Approximately half of PCa patients experience a second BCR after postoperative radiotherapy. Time to recurrence, PSA kinetics, adverse pathological features (ISUP 4-5, pT3-4, and positive surgical margins), alongside genetic profile, are key factors for risk stratification. Combination of androgen deprivation therapy (ADT) and novel androgen receptor pathway inhibitors (ARPIs) represents an established treatment choice. However, recent findings emphasize the growing role of prostate-specific membrane antigen (PSMA) PET in detecting recurrent disease and guide tailored strategies. Based on early phase II trials and retrospective studies, metastasis-directed therapy (MDT) has demonstrated promising efficacy in oligorecurrent PCa, although further validation is warranted.
BCR after radical prostatectomy and postoperative radiotherapy represents a challenge in PCa management. Risk stratification is key for guiding the addition of ARPIs to standard ADT. PSMA PET may further refine tailored strategies such as MDT, whose promising efficacy needs further exploration. Ongoing trials will clarify treatment sequencing and patient selection in the evolving paradigm of BCR management.
本综述探讨了前列腺癌（PCa）根治性前列腺切除术后及术后放疗后生化复发（BCR）管理中的挑战，重点关注风险分层、影像学及新兴疗法方面的差距，以及分子影像学和个性化治疗的进展。
约一半的PCa患者在术后放疗后会出现第二次BCR。复发时间、前列腺特异性抗原（PSA）动力学、不良病理特征（国际泌尿病理学会[ISUP]4 - 5级、pT3 - 4级及手术切缘阳性）以及基因谱是风险分层的关键因素。雄激素剥夺疗法（ADT）与新型雄激素受体通路抑制剂（ARPIs）联合是一种既定的治疗选择。然而，最近的研究结果强调了前列腺特异性膜抗原（PSMA）正电子发射断层扫描（PET）在检测复发性疾病和指导个性化策略方面日益重要的作用。基于早期II期试验和回顾性研究，转移导向治疗（MDT）在寡转移性复发性PCa中已显示出有前景的疗效，不过仍需进一步验证。
根治性前列腺切除术后及术后放疗后的BCR是PCa管理中的一项挑战。风险分层是指导在标准ADT基础上加用ARPIs的关键。PSMA PET可能会进一步优化如MDT等个性化策略，其有前景的疗效需要进一步探索。正在进行的试验将在不断演变的BCR管理模式中明确治疗顺序和患者选择。
