Loizos Loizou, Head of Cyprus International Action Plan for Children with Cancer at ELPIDA Foundation for Children with Cancer, shared on LinkedIn:
“My friends,
Prostate cancer: How is recurrence detected earlier?
The problem
After surgery or radiation therapy for prostate cancer, an increase in PSA may be the first sign of a recurrence.
In the early stages, however, the focus of the disease is often not visible with conventional imaging tests, such as CT and bone scintigraphy.
The new approach
The guidelines of the European Association of Urology (EAU) significantly strengthen the role of PSMA PET/CT, a special form of PET scan, in investigating biochemical recurrence:
- After radical prostatectomy: PSMA PET/CT is recommended when the PSA is >0.2 ng/mL, as long as the result may affect the treatment decision.
- After radiotherapy: It is recommended for patients who are candidates for salvage therapy.
Why is it important?
- PSMA PET/CT has much higher sensitivity to low PSA values.
- Even when the PSA is just 0.2–0.5 ng/mL, about 48% of tests are already positive.
Thus, it can be determined earlier whether the recurrence is local, involves lymph nodes or is located in remote places, allowing for more personalized treatment planning.
Do all patients need PSMA PET/CT?
Nope. The decision depends on the progression and speed of PSA increase, the initial risk of the disease, previous treatment and, above all, whether the result of the test will change the treatment.
Also, a negative PSMA PET/CT does not rule out microscopic disease and does not in itself negate the indication for rescue treatment.
Practical application in clinical practice
An increase in PSA after radical treatment requires early evaluation. PSMA PET/CT now offers the possibility to know much earlier where the recurrence is, so that the next therapeutic move can be planned more targeted.
Source: European Association of Urology (EAU). Guidelines on Prostate Cancer, 2026 – Management of PSA-only recurrence after treatment with curative intent.”
Loizos G. Loizou was recognized among OncoDaily’s 100 Most Influential People in Oncology in 2025, highlighting their contributions to the field of oncology.
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