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While androgen deprivation therapy (ADT) remains a foundational approach, its routine use in low- and intermediate-risk BCR raises concerns regarding overtreatment and long-term quality-of-life (QOL) impairment. This review summarizes contemporary testosterone-sparing treatment (TST) strategies for BCR, including patient selection frameworks, emerging therapeutics, and evolving imaging modalities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Recent Findings<\/jats:title>\n                    <jats:p>Advances in multifactorial risk stratification\u2014including genomic classifiers and artificial intelligence (AI)-driven models\u2014are reshaping treatment decision-making and may help identify patients unlikely to benefit from ADT. PSMA-PET has redefined disease staging and is increasingly used to guide salvage radiation therapy and metastasis-directed therapy. Several emerging TST strategies\u2014including enzalutamide monotherapy, salvage radiation without ADT, metastasis-directed therapy, salvage lymph node dissection, radioligand therapy, and structured lifestyle interventions\u2014demonstrate potential to delay or avoid hormonal therapy. Early evidence suggests select patients can maintain cancer control while avoiding testosterone suppression and its associated toxicities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>BCR represents a heterogeneous clinical state, requiring individualized management strategies that balance oncologic efficacy with long-term survivorship concerns. Testosterone-sparing approaches may provide safe alternatives to ADT in appropriately selected patients. Ongoing work to validate predictive biomarkers and integrate AI-derived decision tools is expected to refine patient selection as emerging clinical trials mature.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11912-026-01776-5","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T03:24:25Z","timestamp":1774927465000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Testosterone-Sparing Treatment Strategies for Biochemically Recurrent Prostate Cancer After Radical Prostatectomy"],"prefix":"10.1007","volume":"28","author":[{"given":"Faris","family":"Najdawi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rashid K.","family":"Sayyid","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Ahlering","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David I.","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan W.","family":"Dobbs","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed","family":"Shahait","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"issue":"4","key":"1776_CR1","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1001\/jama.294.4.433","volume":"294","author":"SJ Freedland","year":"2005","unstructured":"Freedland SJ, et al. 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