Overcoming barriers to acting on rapidly rising PSA in biochemically recurrent prostate cancer

In this video, Alicia Morgans, MD, MPH, barriers to physicians recognizing and acting on rapidly rising prostate-specific antigen (PSA) levels in men. She is an author of the study “Impact of physicians’ awareness of prostate-specific antigen doubling time (PSADT) on treatment (Tx) decisions in high-risk (HR) biochemically recurrent (BCR) prostate cancer (PC),” which she presented at the 2025 American Society of Clinical Oncology Genitourinary Cancers Symposium in San Francisco, California. Morgans is a genitourinary medical oncologist and the director of the Survivorship Program at Dana-Farber Cancer Institute in Boston, Massachusetts.

Transcription:

You found a higher proportion of patients with uPSADT had a fast PSADT. What potential barriers do you see preventing physicians from recognizing and acting on a rapidly rising PSA in these patients, and how can these barriers be overcome?

I think that 1 of the main reasons physicians weren't necessarily acting is that they weren't getting a full picture of how aggressive the disease was, because even when they were calculating the PSA doubling time, they were often overestimating that, which means they were underestimating the aggressiveness of the cancer. So having a reliable calculation would be important. And then I also think that medical education around the recent approvals in the biochemical recurrent state is important as well. Until about a year and a half ago—and I could be getting that that timeline a little bit off—we really didn't have medicines that we knew would actually improve meaningful outcomes for patients with prostate cancer. We were using things like intermittent androgen deprivation therapy, but not because we had any data to suggest that it would prolong the time to metastasis, improve quality of life, or prolong survival, but just because we needed something and it was available. It just was understudied, and the trials that investigated it were actually under enrolled and didn't meet statistical power to answer the questions that we were asking. However, about a year and a half ago or so, we did have the EMBARK trial report out, and this study was really the first one to tell us that we could meaningfully intervene in patients with biochemical recurrence with systemic treatments that could prolong the time to metastasis and/or prolong metastasis-free survival. And that's absolutely a regulatory end point, but an end point that's really important to patients as well. So with that approval, we know that we now can use things like enzalutamide, either alone or with a GnRH analog, to prolong time to metastasis, potentially prolong survival, and really to maintain quality of life without meaningful decrement for patients. And so I think it's important that we make sure that we overcome that educational barrier, overcome the miscalculation barrier, and make sure that we apply those treatments for patients in whom they may be appropriate after a shared decision and patient interest in that.

This transcription was AI generated and edited by human editors for clarity.