PURPOSE OF REVIEW: We aimed to summarize the recent advancements in management of biochemical recurrence (BCR) after primary curative therapy for prostate cancer (PCa), and the role of advanced imaging technologies in guiding and improving treatment decisions. RECENT FINDINGS: Recent studies have reshaped the approach to managing BCR after primary treatment for PCa. A key shift is the preference for early salvage radiotherapy (sRT), which has proven to offer comparable or even superior outcomes to immediate adjuvant therapy when closely monitored for progression. PSA kinetics (PSA doubling time) continue to guide treatment decisions, together with the time to PSA rise, Gleason Grade of the original tumor, and PSMA-PET imaging at the time of recurrence. While PSMA-PET significantly enhances the precision of recurrence detection, its sensitivity for smaller pelvic lymph node metastases remains limited, underscoring the need for careful consideration of all factors together to develop a risk-based consulting for all individualized treatment plan integrating patient wishes and health. SUMMARY: Recent studies underscore the efficacy of early sRT in managing BCR, with PSA kinetics and ISUP score as a crucial factor in guiding treatment decisions. Furthermore, the integration of PSMA-PET imaging has improved the precision of recurrence detection, facilitating more tailored and effective treatment strategies for patients with BCR. We are finally entering the age of personalized, risk-based, patient-centred case delivery, where treatment of the primary tumor with curative intent is offered to patients with BCR.

Collegium Medicum Faculty of Medicine WSB University Dąbrowa Górnicza Poland

Department of Oncology Hematology and Bone Marrow Transplantation with Section Pneumology University Center Hamburg Eppendorf Hamburg Germany

Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Urology Centre of Postgraduate Medical Education Warsaw Poland

Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria

Department of Urology Medical University Center Hamburg Eppendorf Hamburg Germany

Department of Urology University of Texas Southwestern Dallas Texas USA

Division of Surgery and Interventional Sciences University College London London UK

Hourani Center for Applied Scientific Research Al Ahliyya Amman University Amman Jordan

Karl Landsteiner Institute of Urology and Andrology Vienna Austria

Research Center for Evidence Medicine Urology Department Tabriz University of Medical Sciences Tabriz Iran

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