Biochemical failure in prostate cancer

Prostate cancer treatment failure after local therapy can be detected through changes in PSA prior to any clinical evidence of disease. Therefore, posttreatment elevation, also called biochemical failure, has been utilized as a surrogate for disease recurrence. The ability to consistently define biochemical failure is important both for the prognostic risk stratification of patients for clinical recurrence and survival and for the standardization of research when comparing multiple series of patients who undergo the same treatment. Due to the difference in PSA posttreatment, the definition of biochemical failure varies between treatments. In this chapter, we will explore the definitions of biochemical failure for each type of prostate cancer treatment, the clinical workup at time of biochemical failure, and the management decisions that clinicians encounter after patients develop biochemical failure.