Usefulness of Tissue Biomarkers versus Prostate-Specific Membrane Antigen-Positron Emission Tomography for Prostate Cancer Biochemical Recurrence after Radical Prostatectomy

Simple Summary Patients undergoing definitive prostate cancer therapy experience recurrence despite standard-of-care interventions. Biochemical recurrence is detected initially via prostate-specific antigen (PSA) monitoring and is defined as biochemical recurrence. The clinical importance of the early detection of biochemical recurrence is underscored in this study. This review seeks to further elucidate modalities used for earlier identification of biochemical recurrence. Specifically, we highlight in this review the clinical utility of both tissue biomarkers and prostate-specific membrane antigen-positron emission tomography (PSMA PET) in monitoring patients for recurrence. The summarization provided in this article can help guide clinicians in understanding the recent developments in this field.Abstract Despite curative-intent local therapy, approximately 27% to 53% of prostate cancer (PCa) patients experience prostate-specific antigen (PSA) recurrence, known as biochemical recurrence (BCR). BCR significantly raises the risk of PCa-related morbidity and mortality, yet there is no consensus on optimal management. Prostate-specific membrane antigen-positron emission tomography (PSMA PET) has emerged as highly sensitive imaging, distinguishing local recurrences from distant metastases, crucially influencing treatment decisions. Genomic biomarkers such as Decipher, Prolaris, and Oncotype DX contribute to refining recurrence risk profiles, guiding decisions on intensifying adjuvant therapies, like radiotherapy and androgen deprivation therapy (ADT). This review assesses PSMA PET and biomarker utility in post-radical prostatectomy BCR scenarios, highlighting their impact on clinical decision-making. Despite their promising roles, the routine integration of biomarkers is limited by availability and cost, requiring further evidence. PSMA PET remains indispensable for restaging and treatment evaluation in these patients. Integrating biomarkers and PSMA PET promises to optimize personalized management strategies for BCR, though more comprehensive consensus-building studies are needed to define their standardized utility in clinical practice.