Biochemical Recurrence in Prostate Cancer: Is it Reportable
Understanding Reportability of Biochemical Recurrence
Yes, prostate cancer with a biochemical recurrence (BCR) is reportable—but only when confirmed by biopsy, imaging, or when treatment is initiated. An elevated PSA alone is not diagnostic of cancer and does not meet reporting criteria.
While rare exceptions exist—such as a combination of a positive digital rectal exam (DRE) and elevated PSA—most cases require histologic, cytologic, or imaging confirmation to establish a diagnosis date.
Key Reporting Considerations
• PSA Alone Is Insufficient: PSA elevation without additional clinical or diagnostic evidence is not reportable.
• PI-RADS Categories 4 & 5: These findings are considered reportable unless contradicted by other clinical information.
• Ongoing Hormonal Therapy: Patients on long-term hormonal treatment with no evidence of active disease are not reportable to FCDS.
Defining Biochemical Recurrence
• Post-Prostatectomy: PSA ≥ 0.2 ng/mL with a confirmatory value of ≥ 0.2 ng/mL.
• Post-Radiation Therapy: PSA increase of ≥ 2 ng/mL above the nadir.
• Biochemical Failure: Defined as a PSA rise following primary treatment. May be the only sign of recurrence when imaging is negative.
• Progression Types: Prostate cancer may progress clinically, radiographically, or biochemically. Biopsy or imaging is recommended to confirm recurrence and guide staging.
2024 American Urological Association (AUA) Recommendations for Salvage Therapy
Following Radical Prostatectomy (RP):
• With High-Risk Features (e.g., PSA ≥ 0.7 ng/mL, Gleason Grade Group 4–5, PSADT ≤ 6 months, seminal vesicle involvement):
➤ Offer androgen deprivation therapy (ADT) + salvage radiation therapy (RT).
• Without High-Risk Features:
➤ Consider radiation therapy alone.
• pN1 Disease:
➤ Include ADT with post-operative RT.
• ADT Duration:
➤ Minimum of 4–6 months; extend to 18–24 months for high-risk patients.
• Radiation Fields:
➤ May include regional lymph nodes in salvage RT.
After Primary Radiation or Ablative Therapy:
• No Metastatic Disease + Candidate for Local Salvage Therapy:
➤ Perform prostate biopsy to confirm local recurrence.
• Biopsy-Confirmed Local Recurrence:
➤ Offer RP, cryoablation, HIFU, or reirradiation as part of shared decision-making.
If the patient presents with a biochemical recurrence before abstracting, ensure it has been confirmed microscopically with a biopsy, imaging, or upon initiation of treatment.
AUA Guidelines on Salvage Therapy (https://www.auanet.org/guidelines-and-quality/guidelines/salvage-therapy-for-prostate-cancer)
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