Background:
Prostate cancer is one of the most common malignancies in the U.S., with recurrent disease posing a significant clinical challenge. Biochemical recurrence is typically indicated by a rising prostate-specific antigen (PSA) level, prompting further evaluation. Recent advances in nuclear imaging—particularly prostate-specific membrane antigen (PSMA) PET—have revolutionized recurrence detection, offering superior sensitivity and specificity compared to conventional modalities. This enables earlier and more accurate restaging and guides salvage therapy decisions.

Methods:
A focused literature search was conducted using PubMed and Google to identify peer-reviewed articles, clinical trials, and guidelines related to recurrence detection and salvage treatment. Keywords included “prostate cancer recurrence,” “PSMA PET,” “androgen deprivation therapy,” and “salvage treatment.”

Results:
PSMA PET imaging now plays a central role in restaging, even at low PSA levels. Emerging biomarkers such as circulating tumor DNA (ctDNA) may complement PSA testing in the future. First-line salvage therapy typically involves total androgen blockade using a GnRH agonist or antagonist with an anti-androgen. GnRH antagonists may offer faster PSA responses and fewer side effects. Continuous androgen deprivation therapy (ADT) is preferred over intermittent regimens in patients with poor prognostic factors.

Local salvage options—such as prostatectomy or reirradiation—are technically complex and best performed at specialized centers. In advanced cases, triplet therapy and radiopharmaceuticals like Radium-223 and ^177Lu-PSMA-617 have shown survival benefits. Psychological support remains essential to address distress and improve quality of life.

Conclusion:
PSMA PET imaging and tailored salvage therapies are reshaping the management of recurrent prostate cancer, requiring multidisciplinary care and ongoing research.

Fatlinda Berisha is a medical student who will soon complete her studies in General Medicine at the University of Prishtina “Hasan Prishtina.” She has a compassion for helping patients and performing research in cancer. She collaborates with seven other classmates in the cancer research team of Professor Patricia Tai in Canada who serves as a mentor for them all.