Does Physician Documentation of Patients' Prostate-Specific Antigen Doubling Time Affect Treatment Decisions in...

Nearly half of patients with prostate cancer experience biochemical recurrence (BCR) within 10 years after definitive treatment. Among them, patients with high-risk BCR are those who have a prostate-specific antigen (PSA) doubling time (PSADT) of ≤ 9 months, which is one of the strongest predictors of poor outcomes. This study aimed to define characteristics and treatment patterns among patients whose PSADT was documented or undocumented by treating physicians at the time of high-risk BCR diagnosis.

Participating physicians from the United States Cardinal Health Oncology Provider Extended Network abstracted medical record data of patients with high-risk BCR into electronic case report forms (index: 2018-2020; follow-up through 2022). Physicians reported PSADT values at index using labs, clinical judgment, or online calculation. If not provided, PSADT was retrospectively calculated using PSA data from the case report forms. Baseline characteristics and treatment patterns were compared between patients with documented versus undocumented PSADT.

Among 284 patients, PSADT was not documented by treating physicians in 180 patients (63%) at the time of high-risk BCR diagnosis. For the 104 patients (37%) for whom PSADT was documented, physicians often overestimated PSADT compared with retrospective calculations based on validated tools, underestimating progression risk. Notably, patients with documented PSADT had a significantly shorter median time to treatment than those with undocumented PSADT (1.0 vs. 6.7 months; hazard ratio: 3.4; 95% confidence interval: 2.6-4.4; P < .0001).

Many patients with high-risk BCR may be unidentified in practice despite widespread availability of PSADT calculators to characterize risk. Physicians that document PSADT are more likely to prescribe treatment early, despite underestimating progression risk (ie, overestimating PSADT). Efforts should be made to improve consistent, accurate PSADT calculation and documentation by physicians to inform treatment decision-making for management of high-risk BCR.