New biochemical recurrence guidelines focus on an individualized approach
Multiple advances in imaging, risk stratification and treatment in the past decade have transformed the management landscape surrounding BCR, and the evidence continues to mature.
Approximately 35% of prostate cancer patients experience biochemical recurrence (BCR) following prostatectomy, with the exact risk depending on individual risk features. New consensus guidelines on salvage therapy for prostate cancer suggest a cure is still possible for many patients with BCR, but the most appropriate approach should be individualized.
From left: Stephen Boorjian, MD; Jack Andrews, MD; and Neeraj Agarwal, MD, FASCO
The guidelines note that balancing undertreatment with overtreatment, utilizing new therapeutic agents and imaging modalities, and optimizing patient selection are critical for improving oncologic outcomes and maintaining patients’ quality of life.
“The optimal management of BCR depends on a lot of factors, including the treatment they received, as well as their risk classification, overall health and preferences,” said Stacy Loeb, MD, MSc, PhD (hon), professor of urology at the New York University Grossman School of Medicine and Manhattan Veterans Affairs in New York City.
One of the key variables is risk stratification. Dr. Loeb said PSA level, Gleason score, tumor stage, lymph node status and surgical margin status are just a few of the factors associated with BCR.
She will lead a panel discussion, “55-Year-Old Male With BCR After Local Therapy: Risk Stratification, Markers, Management of Low- and High-Risk,” during the morning plenary on Friday, May 3, in the Stars at Night Ballroom. Joining her will be Jack Andrews, MD, urologic oncologist at the Mayo Clinic Arizona; Stephen Boorjian, MD, Carl Rosen Professor and chair of urology at Mayo Clinic Rochester; and Neeraj Agarwal, MD, FASCO, professor of medicine and presidential-endowed chair of cancer research at the Huntsman Cancer Institute, University of Utah.
The new AUA/American Society for Radiation Oncology/Society of Urologic Oncology guidelines on salvage prostate cancer therapy were published in The Journal of Urology® in February 2024. The consensus document is intended to bridge the gap between the existing AUA Localized Prostate Cancer Guideline and the Advanced Prostate Cancer Guideline. Multiple advances in imaging, risk stratification and treatment in the past decade have transformed the management landscape surrounding BCR, and the evidence continues to mature.
Approaches to risk stratification are evolving, for example, through the use of molecular markers. At the same time, there is increased understanding of the prolonged natural history and importance of considering side effects and patients’ competing risks when evaluating management options. Evidence-based biomarkers are still under development.
“The implementation of [prostate-specific membrane antigen] diagnostics is rapidly changing the evaluation of these patients. Additionally, while there are no novel liquid biomarkers in this space, this is an active area of research and will likely be transformative over the next 10 years,” Dr. Andrews said.
Dr. Boorjian added, “Our goal in this session is to discuss the new AUA guidelines, share the most recent evidence in this disease space and provide practical guidance for the ‘patient-in-the-clinic-tomorrow’ scenarios.”