How the Management of Biochemical Recurrence in Prostate Cancer Will Be Modified by the Concept of Anticipation and Incrementation of Therapy

The risk of early progression to metastatic disease in the event of biochemical recurrence (BCR) after primary treatment for prostate cancer (PC) is extremely variable. PSA-doubling time (DT) is the best parameter currently available to define patients who are at a higher risk of progression, but a single temporal parameter is not sufficient to describe the heterogeneity of this condition. A real precision medicine approach is strongly suggested to offer tailored management to patients with biochemical relapse. At present, patients with low-risk BCR should be offered active observation, while patients with high-risk BCR are likely to benefit from early systemic therapy. Results from the EMBARK study are likely to impact how physicians choose to manage high-risk BCR. The introduction of the concept of anticipation and intensification of treatment through the use of androgen receptor signaling inhibitors (ARSIs) and ADT combination therapy in this indolent but crucial phase is the main innovation of the study. The aim of this review is to provide a comprehensive understanding of the definition, classification, diagnosis, and treatment modalities of BCR, with a focus on the latest innovations and ongoing trials in the management of high-risk BCR.