Study: PSADT is often undocumented in high-risk biochemical recurrence

A substantial proportion of patients with high-risk biochemical recurrence of prostate cancer may go unidentified in routine clinical practice because prostate-specific antigen doubling time is often not calculated or documented, according to findings from a recent real-world analysis.¹

The study evaluated treatment patterns and physician documentation practices among patients with high-risk BCR, defined primarily by a PSADT of 9 months or less. Investigators found that among 284 patients included in the analysis, PSADT was not documented by treating physicians in 180 cases at the time of high-risk BCR diagnosis. Moreover, when PSADT was documented, physicians frequently overestimated the value compared with retrospective calculations using validated tools, potentially underestimating disease aggressiveness.

“These were patients that physicians themselves identified as having high-risk biochemical recurrence,” said Stephen J. Freedland, MD, a professor of urology at Cedars-Sinai in Los Angeles, California. “And then one of the questions we asked was, ‘What is the patient’s PSA doubling time?’ Amazingly, almost two-thirds of the time, the physician’s response was, ‘I don’t know.’”

The retrospective study used data abstracted by participating physicians from the United States Cardinal Health Oncology Provider Extended Network. Physicians entered patient medical record data into electronic case report forms for patients diagnosed with high-risk BCR between 2018 and 2020, with follow-up through 2022. Physicians could report PSADT based on laboratory data, clinical judgment, or online calculators. When PSADT was not documented, investigators retrospectively calculated it using PSA data from the records.

Freedland said one of the study’s most notable findings was the association between PSADT documentation and treatment timing. Patients whose PSADT was documented received salvage treatment substantially sooner than those without documented PSADT.

“Those patients were treated much more aggressively, much more rapidly,” Freedland said. “It showed the importance of, if you’re trying to risk stratify the patient, you’ve got to know the basic information of how we risk stratify, which is doubling time.”

The data supported that observation. Median time to treatment was 1.0 month among patients with documented PSADT compared with 6.7 months among those without documented PSADT, translating to a hazard ratio of 3.4.

Investigators also assessed the accuracy of physician-reported PSADT by independently recalculating doubling times using all available PSA values. According to Freedland, physician estimates frequently underestimated progression risk.

“In the patients where they did tell us the doubling time, they weren’t that accurate,” he said. “Almost always they estimated a longer doubling time than the real doubling time. Longer doubling time means less aggressive disease.”

The findings carry particular relevance as treatment options for hormone-sensitive high-risk BCR continue to expand, noted Alicia K. Morgans, MD, MPH, a genitourinary medical oncologist at Dana-Farber Cancer Institute in Boston, Massachusetts.

“This is particularly important in the era of EMBARK,” Morgans said, referring to recent data supporting earlier intervention in high-risk BCR. “When people have high-risk biochemical recurrence in this hormone-sensitive setting, not only are we prolonging the time to metastasis, we’re prolonging survival for these patients, which is incredible.”

Morgans emphasized that failure to calculate PSADT may contribute directly to delays in initiating appropriate therapy.

“When people are not even calculating it, of course getting them to treatment is going to be delayed, which was evidenced here,” she said.

She added that integrating PSADT calculations into routine clinical workflows could improve continuity of care and treatment decision-making.

“When we see patients with biochemical recurrence, calculate the PSA doubling time, document it, so that whether you’re following up the patient at the next visit, or whether a PA, NP, or physician colleague is following up, they at least have a benchmark,” Morgans said.

According to the investigators, the findings highlight a need for greater physician education and more consistent use of validated PSADT calculators to accurately identify patients with high-risk BCR who may benefit from earlier treatment intensification.

REFERENCE

1. Morgans AK, Touya M, El-Chaar N, et al. Does physician documentation of patients' prostate-specific antigen doubling time affect treatment decisions in high-risk biochemically recurrent prostate cancer? Clin Genitourin Cancer. 2026;24(2):102496. doi: 10.1016/j.clgc.2025.102496