Evolution of salvage therapy for biochemical recurrence of prostate cancer after radical prostatectomy

Biochemical recurrence (BCR) is quite common after radical prostatectomy (RP), but so far effective treatment options for such patients remain controversial. Although prostate specific antigen (PSA) is widely used as a marker of survival in prostate cancer (PCa), it cannot fully differentiate between overall and tumor-specific survival. Given that biochemical recurrence does not always translate into clinical recurrence, it is difficult for clinicians to determine the timing of treatment to stop or slow progression.There are several treatment options for BCR after undergoing RP: postoperative or adjuvant external beam radiation therapy (ART), salvage external beam radiation therapy (SRT) for the resected prostate bed and/or regional lymphatic system, continuous or intermittent androgen deprivation therapy (ADT), experimental techniques, and dynamic follow-up. ART after RP has survival advantages, but is not recommended because of significant early and late radiation complications. SRT is recommended for patients with BCR after RP. In selecting the best treatment strategy, it is necessary to consider comorbidities, patient preferences, and clinical and pathomorphological characteristics of the tumor.