Biochemical Recurrence (Prostate Cancer)
Biochemical recurrence (BCR) is a rising PSA after definitive treatment — a signal that prostate cancer has come back before it's clinically or radiologically obvious.
The big picture
Biochemical recurrence (BCR) is a rising PSA after definitive treatment — a signal that prostate cancer has come back before it's clinically or radiologically obvious. The key skills are knowing the PSA threshold that defines recurrence (which differs for surgery vs radiation), then restaging to find where it is (increasingly with PSMA PET), and choosing salvage therapy. It's a "the lab is telling you something the scan can't yet" problem.
The framework: define BCR (different for RP vs radiotherapy) → restage (PSMA PET) → salvage therapy directed by the likely site of recurrence.
Mechanism pathway
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Diagnostic algorithm
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Board traps
BCR after prostatectomy = PSA ≥0.2 ng/mL (confirmed); after radiotherapy = nadir + 2 (Phoenix). Different definitions — high-yield.
PSMA PET/CT is the restaging modality — detects recurrence at low PSA, changes management.
Local recurrence → salvage radiotherapy (post-RP) given early (lower PSA = better).
Metastatic recurrence → systemic therapy (ADT ± intensification).
PSA doubling time separates indolent from aggressive recurrence.