Onkologie. 2026:20(3):136-140 | DOI: 10.36290/xon.2026.025

Diagnosis and treatment of biochemical recurrence of prostate cancer after radical therapy

Otakar Čapoun

Urologická klinika 1. LF UK a VFN, Praha

Biochemical recurrence (BCR) of prostate cancer represents a common clinical scenario after radical prostatectomy (RP) or radiotherapy (RT), with heterogeneous biological behavior ranging from indolent disease to rapid metastatic progression. Appropriate interpretation of BCR requires a precise definition according to the type of primary treatment, assessment of prostate-specific antigen (PSA) kinetics, and risk stratification. Positron emission tomography targeting prostate-specific membrane antigen enables localization of recurrence even at low PSA levels and significantly influences the selection and targeting of salvage treatment. In patients with BCR after RP, early salvage radiotherapy remains the standard approach with curative potential, with available data supporting its initiation at low PSA values. After failure of definitive RT, careful patient selection, histological confirmation of local recurrence, and an indivi­dualized approach to local salvage modalities or systemic therapy are required. A major milestone in the management of high-risk BCR is the intensification of hormonal therapy, the benefit of which was demonstrated in the EMBARK trial. Consequently, contemporary management of BCR in prostate cancer is shifting toward personalized, multidisciplinary care based on the integration of clinical, biological, and advanced imaging parameters.

Keywords: prostate cancer, biochemical recurrence, PSMA PET, salvage radiotherapy, hormonal therapy.

Accepted: June 15, 2026; Published: July 1, 2026  Show citation