Dr Morgans on PSA Doubling Time and Treatment Decisions in Biochemically Recurrent nmHSPC

“If we are inaccurately saying that the doubling time is longer [than the true doubling time] and then not treating patients because of that, we are potentially missing an opportunity to intervene for patients who may benefit from treatment.”

Alicia Morgans, MD, MPH, a genitourinary medical oncologist and medical director of the Survivorship Program at Dana-Farber Cancer Institute; and an associate professor of medicine at Harvard Medical School, discusses findings from a retrospective analysis evaluating how prostate-specific antigen (PSA) doubling time is used in clinical practice to guide treatment decisions in patients with high-risk biochemically recurrent (BCR), nonmetastatic hormone-sensitive prostate cancer (nmHSPC). The study, findings from which were presented at the 2025 Genitourinary Cancers Symposium, aimed to assess both the frequency and accuracy of PSA doubling time documentation and its impact on therapeutic decision-making in this population.

Morgans notes that 1 of the key findings from the analysis was that PSA doubling time was not documented or could not be abstracted in approximately two-thirds of patients evaluating during the study. Among patients for whom PSA doubling time was documented, patients were generally older; had a faster PSA recurrence following definitive local therapy after diagnosis; had higher Gleason scores; had poorer performance status, or had elevated baseline PSA levels. These findings suggest that clinicians may be more inclined to assess PSA doubling time in patients already perceived as high-risk for recurrence due to other clinical characteristics.

Moreover, when PSA doubling was calculated, it was frequently overestimated. This overestimation may reflect a tendency among providers to underestimate the aggressiveness of the disease. Since a longer PSA doubling time is associated with less aggressive disease, this miscalculation could result in clinicians forgoing treatment in patients who may benefit from earlier intervention.

These findings underscore the need for standardized calculation and consistent documentation of PSA doubling in patients with BCR nmHSPC, Morgans explains. She emphasizes that increased physician awareness and integration of PSA doubling time into routine clinical workflows are critical to improving care for this patient population.