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PCWG3-defined PSA progression on systemic prostate-cancer therapy: ≥25% rise from nadir +...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

IDRF-PROSTATE-PSA-PROGRESSION
TypeRed flag
Statusreviewed 2026-04-26 | pending_clinical_signoff
DiseasesDIS-PROSTATE
SourcesSRC-EAU-PROSTATE-2024 SRC-NCCN-PROSTATE-2025

Red Flag Origin

DefinitionPCWG3-defined PSA progression on systemic prostate-cancer therapy: ≥25% rise from nadir + ≥2 ng/mL absolute increase, confirmed by a second value ≥3 weeks later. Triggers re-imaging + MDT consideration of next-line therapy switch — but NOT alone sufficient to change line if radiographic + clinical disease stable (per PCWG3 + STAR criteria).
Clinical directioninvestigate
Categorytransformation-progression

Trigger Logic

{
  "any_of": [
    {
      "finding": "psa_progression_pcwg3_confirmed",
      "value": true
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "psa_rise_pct_from_nadir",
          "threshold": 25
        },
        {
          "comparator": ">=",
          "finding": "psa_abs_increase_ng_ml",
          "threshold": 2
        },
        {
          "finding": "psa_progression_confirmed_3wk",
          "value": true
        }
      ]
    }
  ],
  "type": "composite_score"
}

Notes

PSA-only progression on ARPI / chemotherapy is common (~30-40% of patients show PSA flare or transient rise). PCWG3 explicitly cautions against line switch on PSA alone — radiographic progression (RECIST 1.1 for soft tissue, PCWG3 bone-scan rules) or new symptomatic events must accompany the PSA finding. This RF surfaces the signal for MDT; it does not auto-switch tracks. Action lives in monitoring schedule (re-image at PSA-progression event), not in `shifts_algorithm`.

Used By

Indications