How to cite: Goodman OB. “Optimal Management of Biochemical Recurrence.” Grand Rounds in Urology. October 23, 2025. Accessed Oct 2026. https://grandroundsinurology.com/optimal-management-of-biochemical-recurrence/
Summary
Oscar B. Goodman, Jr., MD, PhD, Medical Oncologist, Nevada Oncology Specialists, Las Vegas, Nevada, provides a practical, evidence-based framework for managing biochemical recurrence after definitive therapy for prostate cancer. Dr. Goodman emphasizes that biochemical recurrence is common and heterogeneous, representing a critical interface between potentially curable disease and incurable metastatic progression.
Definitions of biochemical recurrence after surgery and radiation therapy are reviewed, along with natural history data demonstrating the prognostic importance of prostate-specific antigen (PSA) doubling time, time to recurrence, and tumor grade. The presentation emphasizes the role of validated prognostic and predictive tools, including CAPRA-S, Decipher, the Stephenson nomogram, and PAM50 molecular subtyping, in guiding treatment decisions.
Recent advances in imaging and systemic therapy are highlighted. Prostate-specific membrane antigen positron emission tomography (PSMA PET) imaging is shown to provide meaningful prognostic information, with negative scans predicting favorable progression-free outcomes after salvage radiotherapy. The EMBARK trial is considered a landmark study in secondary biochemical recurrence, demonstrating improved metastasis-free survival and an emerging overall survival benefit with enzalutamide-based strategies administered intermittently.
Dr. Goodman advocates patient-centered strategies aimed at proactive disease management. Observational data supporting aspirin use, vigorous exercise, and low-carbohydrate dietary interventions are reviewed, underscoring the importance of patient engagement alongside evidence-based oncologic care.
About the 28th Annual Southwest Prostate Cancer Symposium:
Presented by Program Chairs Nelson N. Stone, MD, Richard G. Stock, MD, and William K. Oh, MD, this conference educated attendees about advances in the management of localized and advanced prostate cancer, with a focus on imaging, technology, and training in the related devices. It included a scientific session, as well as live demonstrations of surgical techniques. You can learn more about the conference here.
ABOUT THE AUTHOR
Oscar B. Goodman Jr., MD, PhD, is a physician-scientist and genitourinary oncologist who has been practicing as a hematologist, medical oncologist, and clinical researcher in Las Vegas since 2007, joining Nevada Oncology Specialists in early 2025. He participates in basic, translational, and clinical research studies. His translational research interests center on understanding the mechanisms that govern prostate cancer’s therapeutic resistance. He has authored numerous abstracts, book chapters, and more than 50 peer-reviewed publications. He has also received peer-reviewed prostate cancer research support through the Department of Defense.
