Biochemical recurrence (BCR)

Biochemical recurrence is a rising PSA after treatment for prostate cancer, usually years before anything is visible on a scan. It is defined as a PSA of 0.2 ng/mL or more after prostatectomy, or a rise of 2 ng/mL above the nadir after radiation. PSMA PET, with agents such as fluciclovine F-18 and Illuccix, can now find the recurrent disease at very low PSA levels in most men, opening the way to salvage radiation or metastasis-directed therapy. The EMBARK trial, reported in 2023, showed that enzalutamide with or without androgen deprivation delays metastasis in high-risk recurrence defined by a short PSA doubling time. The term is linked from the PSA entry and from ideas on PSMA-PET-guided metastasis-directed therapy and on localising residual disease.