Table 1 Treatment guidelines for BCR.
EAU/EANM/ESTRO/ESUR/ ISUP/SIOG [16] | NCCN [9] | ||||||||
|---|---|---|---|---|---|---|---|---|---|
Post-RP | Post-EBRT | Post-RP | Post-EBRT | Post-RP | Post-EBRT | Post-RP | Post-EBRT | ||
BCR definition | PSA increase of 0.2 ng/ml AND confirmatory value of ≥0.2 ng/ml | PSA increase of >2 ng/ml over PSA nadir | Detectablea PSA with a subsequent rise | PSA increase of >2 ng/ml over PSA nadir | PSA > 0.4 ng/ml and rising | PSA increase of >2 ng/ml over PSA nadir | Detectablea PSA that increases on ≥2 confirmatory tests or increases to PSA levels >0.1 ng/ml | PSA increase of >2 ng/ml over PSA nadir | |
PSA monitoring post-treatment | Yr ≤10: pt preference and risk of recurrence; Yr >10: high-risk patients onlyb | No recommendations | Yr 1: 3, 6, 12 mo; Yr 2–3: every 6 mo; Yr >3: annually | Yr 1–5: 6–12 mo; Yr >5: annually | Yr 1–5: every 6 mo; Yr >5: annually | ||||
High-risk pts: every 3 moc | High-risk pts: every 3 moc | ||||||||
Observation/active surveillance | Observation recommended for pts with BCR and no evidence of metastatic disease by conventional imaging | Active surveillanced can be offered to pts with low-risk BCR post-RPe and/or post-EBRTf | Observation recommended for pts with: PSADT > 12 mos AND pathological GS < 8 for RP; interval to biochemical failure >18 mos AND GS < 8 for RT | Observation recommended for pts with no distant metastasis or no prior imaging; as an alternative to EBRT ± ADT | Observation recommended for pts and no distant metastasis; as an alternative to ADT if positive TRUS biopsy and LE ≤ 10 yr; as an alternative to RP + PLND, brachytherapy, cryotherapy or HIFU if positive TRUS and LE > 10 yr | ||||
sEBRT (post-RP setting) | Early treatment recommended (PSA levels ≤1.0 ng/ml) with no evidence of distant metastatic disease; ADT + sEBRT recommended when PSA ≥ 0.2 ng/ml | Not recommended | Low-risk BCR, not recommended; high-risk BCR, early treatment recommended (PSA levels ≤0.5 ng/ml) | Early treatment for pts with detectable PSA levels (≥0.2 ng/ml); pts with high Decipher GC scores (GC > 0.6) should be strongly considered for sEBRT and the addition of ADT when early sEBRT is missed | |||||
sADT | Not routinely recommended | iADT may be offered to pts with high-risk BCR after RPg and/or EBRTh | Low-risk BCR, not recommended; high-risk BCR (PSADT, <6–12 mo; GS, >7), early treatment recommended | Early treatment for pts with elevated PSA + shorter PSADT ([≤6 mo] or rapid PSA velocity) + LE ≥ 10 yr | |||||
Surgical and non-surgical salvage treatments (post-EBRT setting) | Not recommended | Not recommended | sRP, SBRT, brachytherapy, HIFU, or cryosurgical ablation should only be offered to highly selected pts with biopsy-proven local recurrence as part of a clinical trial or in experienced centers | Cryosurgery and HIFU in the absence of metastatic disease; brachytherapy and sRP for select pts | |||||
