Biochemical Recurrence

• Biochemical recurrence definition: A rise in PSA levels after prostate cancer treatment, signaling potential disease return.
• It is detected through regular PSA blood tests, often without any physical symptoms of biochemical recurrence.
• The timing and rate of PSA rise help determine the next steps in management.
• It does not always mean immediate clinical recurrence or metastasis, but necessitates close follow-up.

What is Biochemical Recurrence?

What is biochemical recurrence? This term describes a situation where prostate cancer, despite initial treatment like surgery or radiation, shows signs of returning through an increase in prostate-specific antigen (PSA) levels in the blood. PSA is a protein produced by both cancerous and non-cancerous cells in the prostate. After successful treatment, PSA levels should ideally drop to very low or undetectable levels. A sustained rise above a certain threshold, typically 0.2 ng/mL after radical prostatectomy or a rise of 2 ng/mL above the nadir (lowest point) after radiation therapy, is considered a biochemical recurrence definition.

It’s important to understand that biochemical recurrence is a laboratory finding, not a clinical diagnosis of symptomatic cancer. It indicates the presence of prostate cancer cells somewhere in the body, but these cells may be localized or have spread. This early detection allows for timely intervention and management strategies, often long before any physical symptoms develop.

When Does Biochemical Recurrence Occur?

Biochemical recurrence after prostate cancer treatment can occur at various times, ranging from months to many years post-treatment. The timing depends on several factors, including the original stage and grade of the cancer, the type of initial treatment, and individual patient characteristics. For men who undergo radical prostatectomy, biochemical recurrence is typically defined by two consecutive PSA readings of 0.2 ng/mL or higher. Following radiation therapy, the definition often involves a rise of 2 ng/mL above the lowest PSA level achieved after treatment (the nadir).

Regular PSA testing is crucial for monitoring patients post-treatment to detect any rise early. While a significant percentage of men will experience biochemical recurrence—estimates suggest 20-40% after radical prostatectomy and 30-50% after radiation therapy within 10 years, according to general medical consensus—not all will progress to clinically significant disease or require immediate further treatment. The rate at which PSA levels rise, known as PSA velocity, and the time it takes for PSA to double, called PSA doubling time, are important factors in assessing the aggressiveness of the recurrence and guiding subsequent treatment decisions.

Symptoms of Biochemical Recurrence

One of the defining characteristics of biochemical recurrence is that it typically presents with no physical symptoms. The rise in PSA levels is usually the only indicator that the cancer may be returning. This is why regular follow-up PSA tests are so vital after initial prostate cancer treatment. Patients often feel completely healthy and experience no changes in their urinary function, pain levels, or general well-being at this stage.

If the cancer progresses beyond biochemical recurrence to a more advanced, clinical recurrence, then symptoms might eventually develop. These potential symptoms are not directly part of biochemical recurrence itself but are associated with the progression of the disease. They could include bone pain if the cancer has spread to the bones, urinary problems such as difficulty urinating or blood in the urine if the cancer has recurred locally in the prostate bed, or fatigue. However, at the stage of biochemical recurrence, the absence of physical signs underscores the importance of laboratory testing for early detection and intervention.