Session

Overview: Biochemical recurrence (BCR) after primary local treatment for prostate cancer remains a clinical challenge. Recent evidence suggests that high-risk non-metastatic BCR, defined by a rapid PSA doubling time, warrants systemic treatment intensification with androgen receptor pathway inhibitors, which significantly delay metastasis, disease progression, and potentially improve survival. Next-generation imaging, particularly PSMA-PET, enables earlier detection of oligometastatic disease, refining treatment strategies. This has led to growing interest in metastasis-directed therapy (MDT), such as SBRT, as a means to improve clinical outcome in this disease setting. Emerging data indicate that MDT, either alone or in combination with systemic treatment, can improve progression-free survival and delay systemic progression. However, key questions remain regarding optimal patient selection, treatment sequencing, and long-term outcomes. This session will provide a state-of-the-art overview of management of high-risk BCR after prostate cancer primary local treatment, addressing current evidence and unmet clinical needs to refine personalized treatment strategies.