Abstract:
Background: Recurrent prostate cancer is detected by a rising prostate-specific antigen (PSA) level. Recent advances in prostate-specific membrane antigen (PSMA) positron-emission tomography (PET) have improved restaging and subsequent management.
Objective: To summarize recent advancements in PSMA PET imaging and salvage treatment for recurrent prostate cancer after radiation therapy.
Methods: PubMed and Google were searched for (1) new approaches to recurrence detection and (2) optimal subsequent treatments.
Results: Early recurrence is currently detected using the PSA test, defined as an increase to 2+nadir after prior irradiation (Phoenix criteria). PSMA PET is increasingly used for restaging, offering advantages over conventional computed tomography and bone scans. Circulating tumor deoxyribonucleic acid (DNA) warrants further research. Total androgen blockade with gonadotropin-releasing hormone (GnRH) agonists/antagonists combined with anti-androgen therapy is preferred over monotherapy. GnRH antagonists elicit earlier PSA and clinical responses with fewer complications than agonists. Intermittent androgen deprivation therapy (ADT) should be avoided in patients with a short PSA doubling time, high Gleason scores, or distant metastases due to poorer survival outcomes compared to continuous ADT. Prostatectomy following radiotherapy or reirradiation is technically demanding due to post-radiotherapy fibrosis and should be performed at centers of excellence due to high potential morbidity. Triplet therapy or early use of radium-223 may be beneficial, especially in young, fit patients with widespread metastases. Cancer recurrence is distressing, and supportive treatments play a crucial role in enhancing patient compliance.
Conclusion: Prostate cancer recurrence is primarily detected via PSA blood testing, followed by PSMA PET imaging, which is now preferred over conventional scans. Management strategies vary. This work highlights key updates and controversial areas in treatment, including surgery, reirradiation, and systemic chemotherapy/immunotherapy. It serves as a valuable resource for patients and researchers.
