Roessler Navid, Miszczyk Marcin, Strewinsky Nadja, Rajwa Paweł, Shariat Shahrokh F
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Department of Urology, Medical University Center Hamburg-Eppendorf, Hamburg, Germany.
Curr Opin Urol. 2025 Sep 1;35(5):517-521. doi: 10.1097/MOU.0000000000001312. Epub 2025 Jul 7.
We aimed to summarize the recent advancements in management of biochemical recurrence (BCR) after primary curative therapy for prostate cancer (PCa), and the role of advanced imaging technologies in guiding and improving treatment decisions.
Recent studies have reshaped the approach to managing BCR after primary treatment for PCa. A key shift is the preference for early salvage radiotherapy (sRT), which has proven to offer comparable or even superior outcomes to immediate adjuvant therapy when closely monitored for progression. PSA kinetics (PSA doubling time) continue to guide treatment decisions, together with the time to PSA rise, Gleason Grade of the original tumor, and PSMA-PET imaging at the time of recurrence. While PSMA-PET significantly enhances the precision of recurrence detection, its sensitivity for smaller pelvic lymph node metastases remains limited, underscoring the need for careful consideration of all factors together to develop a risk-based consulting for all individualized treatment plan integrating patient wishes and health.
Recent studies underscore the efficacy of early sRT in managing BCR, with PSA kinetics and ISUP score as a crucial factor in guiding treatment decisions. Furthermore, the integration of PSMA-PET imaging has improved the precision of recurrence detection, facilitating more tailored and effective treatment strategies for patients with BCR. We are finally entering the age of personalized, risk-based, patient-centred case delivery, where treatment of the primary tumor with curative intent is offered to patients with BCR.
我们旨在总结前列腺癌（PCa）初次根治性治疗后生化复发（BCR）管理方面的最新进展，以及先进成像技术在指导和改善治疗决策中的作用。
近期研究重塑了PCa初次治疗后BCR的管理方法。一个关键转变是倾向于早期挽救性放疗（sRT），当密切监测病情进展时，已证明其效果与立即辅助治疗相当甚至更优。前列腺特异性抗原（PSA）动力学（PSA倍增时间）以及PSA升高时间、原发肿瘤的 Gleason分级和复发时的前列腺特异性膜抗原（PSMA）-正电子发射断层扫描（PET）成像继续指导治疗决策。虽然PSMA-PET显著提高了复发检测的精度，但其对较小盆腔淋巴结转移的敏感性仍然有限，这突出了需要综合考虑所有因素，为所有个性化治疗方案制定基于风险的咨询，同时兼顾患者意愿和健康状况。
近期研究强调了早期sRT在管理BCR方面的疗效，PSA动力学和国际泌尿病理学会（ISUP）评分是指导治疗决策的关键因素。此外，PSMA-PET成像的整合提高了复发检测的精度，为BCR患者制定了更具针对性和有效性的治疗策略。我们终于进入了个性化、基于风险、以患者为中心的病例管理时代，即对BCR患者提供具有治愈意图的原发肿瘤治疗。
