TY  - EJOU
AU  - Aragon-Ching, Jeanny B. 
AU  - Madan, Ravi A. 

TI  - Highlighting the NCI’s working group on biochemically recurrent prostate cancer for clinical trial considerations
T2  - Canadian Journal of Urology

PY  - 
VL  - 
IS  - 
SN  - 1488-5581

AB  - Biochemically recurrent prostate cancer (BCR) represents a common clinical challenge following definitive local therapy. While traditionally defined by rising prostate-specific antigen (PSA) levels in the absence of metastatic disease on conventional imaging, the advent of prostate-specific membrane antigen (PSMA) PET has reshaped disease detection. PSMA imaging frequently identifies low-volume, subclinical disease not previously classified as metastatic, raising concerns about overtreatment and inappropriate extrapolation from metastatic castration-sensitive prostate cancer (mCSPC) paradigms. A National Cancer Institute Working Group convened in November 2024 to establish a framework for clinical trial development in this evolving landscape. The group proposed the term PSMA-positive BCR to distinguish this largely indolent disease state from mCSPC, emphasized the importance of paired conventional imaging, and highlighted PSA doubling time as a risk stratification tool. Given favorable long-term outcomes and limited symptoms, future trials should prioritize treatment de-escalation, novel endpoints such as treatment-free survival, and improved quality-of-life measures.
KW  - biochemical recurrence; prostate cancer; prostate-specific membrane antigen (PSMA); Positron emission tomography (PET) scan

DO  - 10.32604/cju.2026.082958