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Updated: Jul 22, 2026
Microarray-based Identification of Individual HERV Loci Expression: Application to Biomarker Discovery in Prostate Cancer
Published on: November 3, 2013
H T Poteat1, P Chen, K R Loughlin
1Clinical Laboratories, Brigham and Women's Hospital, Boston, MA 02115, USA.
This study evaluated how often prostate-specific antigen (PSA) tests were used appropriately in a hospital setting. Researchers reviewed 338 outpatient and 95 inpatient PSA test records and found that about 20% of tests were not aligned with established criteria. Most inappropriate tests were due to excessive and age-inappropriate screening. The study suggests that simple changes to test frequency and age guidelines could eliminate the majority of these tests. The researchers estimated that only one of the inappropriate tests had any real impact on patient care. The findings highlight the need for better adherence to clinical guidelines to improve the appropriateness of PSA testing.
Area of Science:
Background:
The use of prostate-specific antigen (PSA) testing remains controversial due to concerns about overuse and lack of clear clinical benefit. Prior research has shown that PSA testing can detect prostate cancer but also leads to overdiagnosis and unnecessary interventions. No prior work had resolved how to define appropriate use of PSA testing in clinical practice. This gap motivated efforts to establish clear utilization criteria. Existing knowledge includes the association between PSA levels and prostate cancer risk, but uncertainty remains about optimal testing frequency and patient age groups. The study aimed to address this uncertainty by evaluating real-world test use against defined criteria. The goal was to determine how often PSA testing aligns with clinical guidelines. This work builds on prior studies that highlight variability in PSA use across institutions. The study contributes by offering a framework for assessing test appropriateness.
Purpose Of The Study:
The study aimed to assess the appropriateness of prostate-specific antigen (PSA) testing in a clinical setting. Researchers sought to determine how often PSA tests were used according to defined criteria. The focus was on identifying patterns of overuse or misuse of the test. The motivation stemmed from concerns about unnecessary testing and its clinical impact. The study evaluated both outpatient and inpatient test records. The goal was to quantify the proportion of inappropriate tests. The researchers also wanted to estimate the potential clinical impact of reducing inappropriate testing. By analyzing test records against established criteria, they aimed to inform quality improvement efforts.
Main Methods:
The researchers developed criteria for appropriate PSA test use. They applied these criteria to a dataset of PSA results from a tertiary care institution. The dataset included 2,330 outpatient and 95 inpatient tests over six months. A random sample of 14.51% of outpatient results was reviewed. All inpatient results were included in the evaluation. The team assessed each test against the defined appropriateness criteria. They categorized tests by indication, such as screening or monitoring. The researchers also evaluated the age and frequency of testing. They estimated the potential clinical impact of eliminating inappropriate tests.
Main Results:
Among the 338 outpatient tests reviewed, 21% were deemed inappropriate. Of the 95 inpatient tests, 17% were inappropriate. Screening was the most common indication for outpatient testing (52%). Monitoring for cancer recurrence followed at 19%. For inpatients, cancer workup was the leading indication (56%). Screening ranked second among inpatient tests (25%). Of the 87 inappropriate tests, 76% resulted from excessive screening frequency. Only one of these tests influenced clinical management for patients under 75 years. The researchers estimated that 74% of inappropriate tests could be eliminated with simple guidelines.
Conclusions:
The study found that a significant proportion of PSA tests were used in ways inconsistent with defined criteria. The researchers concluded that excessive and age-inappropriate screening was the main issue. They proposed that limiting test frequency and age could reduce inappropriate use. The potential clinical impact of eliminating these tests was minimal in most cases. The findings suggest that current PSA testing practices may not always align with clinical guidelines. The study highlights the need for better adherence to established criteria. The authors propose that quality improvement initiatives could focus on these areas. The results support the idea that simple changes could improve test appropriateness.
The study found that 21% of outpatient and 17% of inpatient PSA tests were inappropriate, with most due to excessive screening frequency.
Researchers established criteria based on age and frequency limits, which were applied to evaluate test use.
Screening accounted for 52% of outpatient tests, likely due to its use for prostate cancer detection in asymptomatic patients.
They estimated that 74% of inappropriate tests could be eliminated with simple guidelines, with minimal clinical impact.
Only 1 of 87 inappropriate tests affected clinical management for patients younger than 75 years.
The authors propose that limiting test frequency and age could reduce inappropriate use without significant clinical harm.
