Editing Biochemical Recurrence (section)

=== Natural history ===
* '''Not all patients with detectable PSA level after radical prostatectomy will have clinical progression''', defined as development of metastatic disease, need for second-line treatment, or death from prostate cancer.
** '''Significant proportion will have a detectable PSA level that plateaus and does not progressively rise.'''
*** '''Potential explanations (3):'''
***# '''Residual benign prostatic tissue''' (often used as the rationale for a detectable PSA level after radiation therapy)
***# '''Non-prostatic source:''' PSA is produced at very low levels by other cells such as the urethral glands and salivary glands
***# '''Residual low-grade prostate cancer destined to follow an indolent course'''
* '''In patients with untreated BCR after radical prostatectomy, the time to clinically meaningful events  may be prolonged'''
**'''<span style="color:#ff00ff">Pound et al. (Landmark study)</span>'''
*** '''<span style="color:#ff0000">Population: Cohort study of 1997 men who underwent radical prostatectomy</span>''' (mostly low risk based on clinical staging) without neo- or adjuvant treatment.
*** '''<span style="color:#ff0000">Results:</span>'''
**** 304 men '''developed biochemical recurrence'''
**** '''<span style="color:#ff0000">Median time from biochemical recurrence to metastasis: 8 years</span>'''
***** In a recent update, metastasis-free survival was 10 years
**** '''<span style="color:#ff0000">Median time from development of metastatic disease to death: 5 years</span>'''
**** '''Thus, the median time from biochemical recurrence to death is more than 13 years.'''
*** Pound, Charles R., et al. "[https://pubmed.ncbi.nlm.nih.gov/10235151/ Natural history of progression after PSA elevation following radical prostatectomy.]" ''Jama'' 281.17 (1999): 1591-1597.
*BCR has an impact on survival, but this effect appears to be limited to a subgroup of patients with specific clinical risk factors.[https://pubmed.ncbi.nlm.nih.gov/30342843/]
**If RP, short PSA-doubling time and a high final Gleason score after RP have a negative impact on survival.
**If RP, short interval to biochemical failure after RT and a high biopsy Gleason score have a negative impact on survival.