Management of high-risk biochemical recurrence in prostate cancer: A GCC Delphi consensus (BEAM Panel).

BACKGROUND

High-risk biochemical recurrence (HR-BCR) of prostate cancer (PC) is a prostate-specific antigen (PSA)-only relapse state in which rapid PSA kinetics predict early metastatic progression. Variation in care pathways across Gulf Cooperation Council (GCC) systems supports the need for shared guidance.

METHODS

The HR-BCR Expert Alignment Meeting (BEAM) convened 11 GCC-based senior clinicians with expertise in genitourinary oncology, including medical oncology, urologic oncology, and radiation oncology representation. A writing committee reviewed evidence up to December 2025 and drafted 19 statements. A modified two-round Delphi process used an anonymous online survey in Round 1 and live QR code-enabled voting in Round 2. Consensus was predefined as ≥80% Agree, with abstentions included in the denominator.

RESULTS

Of 19 initial statements, 17 reached final consensus after two Delphi rounds. The panel standardized BCR definitions after radical prostatectomy (PSA ≥0.2 ng/mL confirmed) and radiotherapy (PSA rise ≥2 ng/mL above nadir), and defined HR-BCR primarily by PSA doubling time ≤9 months. Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) was endorsed as preferred restaging modality and considered sufficient for routine staging in EMBARK-aligned HR-BCR, where available. Management recommendations supported androgen receptor pathway inhibitors (ARPIs) plus androgen deprivation therapy (ADT) intensification for eligible patients, intermittent strategies with defined treatment-holiday and restart triggers, and proactive cardiovascular and bone protection. Enzalutamide plus ADT was endorsed as standard for eligible patients, with enzalutamide monotherapy as an evidence-based alternative for selected men.

CONCLUSIONS

This expert-based consensus provides an evidence-aligned, GCC-relevant pathway to harmonize definition, staging, and management of HR-BCR and to facilitate timely, equitable implementation of contemporary care.