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Real-World Treatment Patterns for Patients with High-Risk Biochemically Recurrent Nonmetastatic Castration‑Sensitive Prostate Cancer.

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Criteria Clinicians Use to Classify Patients as High Risk in Biochemically Recurrent Nonmetastatic

Stephen J Freedland1,2, Amanda Ribbands3, Maëlys Touya4

  • 1Department of Urology, Samuel Oschin Comprehensive Cancer Institute, Cedars‑Sinai Medical Center, 8635 West 3rd Street, 1070W, Los Angeles, CA, 90048, USA. Stephen.Freedland@cshs.org.

Advances in Therapy
|June 24, 2026
PubMed
Summary
This summary is machine-generated.

Physicians identify high-risk prostate cancer recurrence using PSA doubling time and Gleason score. However, their PSA doubling time thresholds are often stricter than guidelines suggest, potentially limiting treatment access.

Keywords:
Castration-sensitiveHigh-riskProstate-specific antigenProstatic neoplasmRecurrence

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Area of Science:

  • Oncology
  • Urology

Background:

  • Nonmetastatic castration-sensitive prostate cancer (CSPC) with biochemical recurrence requires accurate risk stratification.
  • Identifying high-risk patients is crucial for timely and appropriate treatment selection.

Purpose of the Study:

  • To determine the real-world criteria and thresholds used by physicians for classifying high-risk biochemical recurrence in nonmetastatic CSPC.
  • To assess the alignment of physician practices with current clinical guidelines.

Main Methods:

  • A retrospective, cross-sectional survey of urologists and radiation oncologists in the USA was conducted.
  • Physicians reported data for patients diagnosed with high-risk biochemical recurrence between April and November 2023.

Main Results:

  • 87 physicians reported on 460 patients, emphasizing prostate-specific antigen doubling time, absolute PSA rise, and Gleason score for risk stratification.
  • The median prostate-specific antigen doubling time threshold used by physicians was 6.0 months.
  • Physicians frequently used prostate-specific antigen doubling time (58%), Gleason score (44%), and absolute PSA rise (43%) at the patient level.

Conclusions:

  • Physicians utilize multiple clinical factors for high-risk biochemical recurrence, generally aligning with guidelines.
  • Physician-applied prostate-specific antigen doubling time thresholds are often more restrictive than recommended by guidelines.
  • Discrepancies highlight an educational need to potentially broaden access to advanced therapies for eligible patients.