Defining low-value PSA testing in a large retrospective cohort: Finding common ground between discordant guidelines

Area of Science:

• Urology
• Oncology
• Health Services Research

Background:

• Population-level data on low-value prostate-specific antigen (PSA) testing often lacks provider-specific decision-making details.
• Understanding patterns of low-value PSA testing is crucial for improving guideline adherence and patient outcomes.

Purpose of the Study:

• To characterize the frequency and patterns of low-value prostate-specific antigen (PSA) testing.
• To analyze the intervals between repeat PSA tests and associated patient risk factors.

Main Methods:

• Retrospective study utilizing electronic health records from 07/01/2012 to 06/30/2017.
• Identified guideline-defined low-value PSA testing, between-testing intervals, and prevalence of prostate cancer risk factors and comorbidities.

Main Results:

• 21,145 PSA tests were performed on 12,303 men, with low-value testing rates ranging from 23.4% to 56.8%.
• Median interval for repeat tests was 12.6 months; younger men (<55) had more risk factors, while older men (>70) had higher comorbidity rates.
• Screening in younger men occurred despite low risk factor prevalence, and older men exhibited significant comorbidities.

Conclusions:

• Low-value prostate cancer testing is prevalent and often occurs with intervals shorter than recommended.
• Screening practices for younger men and older men with comorbidities warrant re-evaluation.
• Improved clinical guidance for prostate cancer screening is necessary to reduce low-value testing.