The first 60 days: Biochemical recurrence of prostate cancer
Biochemical recurrence is a rising PSA after surgery or radiotherapy with nothing yet visible on scans. Salvage radiotherapy can still cure it after surgery, and for a fast-doubling PSA the EMBARK trial showed that enzalutamide with or without hormone therapy delays spread. Below, week by week, is what OnCo's record of Biochemical recurrence of prostate cancer says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- PathologistNamed in the standard of care for: After prostatectomy, After radiotherapy, local recurrence.
- RadiologistNamed in the standard of care for: After radiotherapy, local recurrence, High-risk biochemical recurrence (doubling time under 9 months).
- SurgeonNamed in the standard of care for: After prostatectomy, After radiotherapy, local recurrence.
- Medical oncologistNamed in the standard of care for: After prostatectomy, After radiotherapy, local recurrence, High-risk biochemical recurrence (doubling time under 9 months), PSMA PET-detected oligorecurrence.
- Clinical oncologist (radiotherapy)Named in the standard of care for: After prostatectomy, After radiotherapy, local recurrence, PSMA PET-detected oligorecurrence.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
Enzalutamide with leuprolide, or enzalutamide alone (EMBARK); PSMA PET before starting; intermittent therapy with treatment suspension when PSA becomes undetectable.
Early salvage radiotherapy to the prostate bed, with or without pelvic nodes and four to six months of androgen deprivation for adverse features; observation for slow doubling times.
Salvage prostatectomy, brachytherapy, cryotherapy or high-intensity focused ultrasound in fit men with biopsy-proven local disease and no metastases on PSMA PET.
Stereotactic radiotherapy to the visible metastases, usually within trials or with hormone therapy; the survival benefit is unproven.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example PSA and PSA doubling time, PSMA PET, Decipher on the prostatectomy specimen, Interval from local therapy to recurrence), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include Biochemical recurrence after prostatectomy, Biochemical recurrence after radiotherapy, High-risk biochemical recurrence.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
After prostatectomy
- For my situation (after prostatectomy), which of the standard options do you recommend and why?Guideline options include: Early salvage radiotherapy to the prostate bed, with or without pelvic nodes and four to six months of androgen deprivation for adverse features; observation for slow doubling times.
- Am I a candidate for Decipher Prostate, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
After radiotherapy, local recurrence
- For my situation (after radiotherapy, local recurrence), which of the standard options do you recommend and why?Guideline options include: Salvage prostatectomy, brachytherapy, cryotherapy or high-intensity focused ultrasound in fit men with biopsy-proven local disease and no metastases on PSMA PET.
High-risk biochemical recurrence (doubling time under 9 months)
- For my situation (high-risk biochemical recurrence (doubling time under 9 months)), which of the standard options do you recommend and why?Guideline options include: Enzalutamide with leuprolide, or enzalutamide alone (EMBARK); PSMA PET before starting; intermittent therapy with treatment suspension when PSA becomes undetectable.
- Am I a candidate for Enzalutamide, Leuprolide (leuprorelin) and GnRH agonists, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of EMBARK apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
PSMA PET-detected oligorecurrence
- For my situation (psma pet-detected oligorecurrence), which of the standard options do you recommend and why?Guideline options include: Stereotactic radiotherapy to the visible metastases, usually within trials or with hormone therapy; the survival benefit is unproven.
Any stage
- Are there clinical trials I could join, for example of PSMA PET, Enzalutamide, SBRT / SABR (stereotactic radiotherapy), PSMA-PET-guided metastasis-directed therapy as a curative strategy in oligorecurrent prostate cancer?Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.
- I read that “Whether treating PSMA PET-detected metastases early lengthens life or only lowers PSA”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “How to spare men with slow doubling times from years of hormone therapy”. How does that affect my plan?Open problems are where trials and second opinions matter most.
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Biochemical recurrence of prostate cancer: the full pageBiochemical recurrence is a rising PSA after surgery or radiotherapy with nothing yet visible on scans. Salvage radiotherapy can still cure it after surgery, and for a fast-doubling PSA the EMBARK trial showed that enzalutamide with or without hormone therapy delays spread.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- Oligometastatic disease: Cancer that has spread to only a few places, which may still be curable by treating each spot.
- PSA (prostate-specific antigen): A blood protein made by the prostate; raised levels prompt further tests, and falling levels show treatment is working.
Every term links to the glossary.