<p><strong>For patients with a rising PSA after exhaustion of local therapy and no demonstrated metastatic disease, clinicians should risk stratify as low- or high-risk. High-risk patients generally are defined as patients with PSADT ≤ 9 months. (<em>Clinical Principle</em>)</strong></p>
Discussion
Discussion
<p>In men with biochemical recurrence (BCR) following definitive local therapy, PSADT is among the most powerful predictors of subsequent metastasis and prostate cancer–specific mortality. Shorter PSADT reflects more aggressive tumor biology and consistently stratifies patients into distinct risk categories. Multiple retrospective cohorts have demonstrated that PSADT independently predicts metastasis after radical prostatectomy and radiation therapy, even after adjustment for Gleason grade and pathologic stage. Accordingly, contemporary guidelines incorporate PSADT into risk stratification schemas to guide intensity of surveillance, timing of advanced imaging (e.g., PSMA PET), and consideration of systemic therapy in high-risk BCR.</p>