近三分之一的前列腺癌（PCa）患者在初级治疗后出现生化复发（BCR）。BCR会增加具有预后不利特征的患者发生远处转移和死亡的风险。这些患者最好采用个体化治疗策略来管理，包括使用临床病理因素、下一代影像学和基因组学检测进行风险分层。本综述在临床试验数据的背景下评估了风险分层在BCR患者管理中的实用性，并参考了欧洲和美国医学学会的最新建议。通过PubMed检索了自2023年5月21日发表的关于BCR后经过根治性前列腺切除术（RP）或外照射放疗（EBRT）的患者治疗的相关研究。欧洲和美国的指南支持BCR的风险分层管理。在RP后，对于有BCR的患者，保留性EBRT（联合或无睾酮抑制疗法[ADT]）是一种被接受的治疗选择。在EBRT后，局部保留疗法（RP，冷冻疗法，高强度聚焦超声波，立体定向体放疗以及低剂量和高剂量种植疗法）表现出相当的复发无瘤生存率，但不同的不良事件剖面，短期和长期表现亦不相同。对于仅有局部复发的情况应使用局部保留疗法，而对于区域或远处复发应考虑使用ADT。在实际操作中，患者通常接受ADT，关于间歇ADT vs.持续ADT的指导存在差异，这是因为需要考虑生活质量的影响。尽管指南协会和医学学会对BCR的治疗缺乏共识，但对患者的风险分层至关重要，因为它可以为个体化治疗方法提供明确选择，并估计不良事件的发生情况。在低风险疾病中，建议观察，而在高风险疾病中，在再次局部治疗失败后，适当的选择可能是ADT和/或参加临床试验。来自BCR患者的正在进行中的临床研究结果应该能够为治疗提供共识。©2023年。作者。

Nearly one-third of patients with prostate cancer (PCa) experience biochemical recurrence (BCR) after primary definitive treatment. BCR increases the risk of distant metastasis and mortality in patients with prognostically unfavorable features. These patients are best managed with a tailored treatment strategy incorporating risk stratification using clinicopathological factors, next-generation imaging, and genomic testing.This narrative review examines the utility of risk stratification for the management of patients with BCR in the context of clinical trial data, referencing the latest recommendations by European and US medical societies.PubMed was searched for relevant studies published through May 21 2023 on treatment of patients with BCR after radical prostatectomy (RP) or external beam radiotherapy (EBRT).European and US guidelines support the risk-stratified management of BCR. Post-RP, salvage EBRT (with or without androgen deprivation therapy [ADT]) is an accepted treatment option for patients with BCR. Post-EBRT, local salvage therapies (RP, cryotherapy, high-intensity focused ultrasound, stereotactic body radiotherapy, and low-dose-rate and high-dose-rate brachytherapy) have demonstrated comparable relapse-free survival rates but differing adverse event profiles, short and long term. Local salvage therapies should be used for local-only relapses while ADT should be considered for regional or distant relapses. In practice, patients often receive ADT, with varying guidance for intermittent ADT vs. continuous ADT, due to consideration of quality-of-life effects.Despite a lack of consensus for BCR treatment among guideline associations and medical societies, risk stratification of patients is essential for personalized treatment approaches, as it allows for an informed selection of therapeutic strategies and estimation of adverse events. In lower-risk disease, observation is recommended while in higher-risk disease, after failed repeat local therapy, ADT and/or clinical trial enrollment may be appropriate. Results from ongoing clinical studies of patients with BCR should provide consensus for management.© 2023. The Author(s).