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Factors associated with appropriate and low-value PSA testing.

Nathaniel Oswald1, Tengda Lin1, Benjamin Haaland1

  • 1Huntsman Cancer Institute and University of Utah, Salt Lake City, UT, USA.

Cancer Epidemiology
|May 4, 2020
PubMed
Summary
This summary is machine-generated.

Prostate-specific antigen (PSA) testing for prostate cancer is often low-value when not guideline-indicated. Patient factors like family history and provider specialty influence testing, especially in men aged 55-65.

Keywords:
Low-value screeningPSA testing

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Area of Science:

  • Urology
  • Health Services Research
  • Preventive Medicine

Background:

  • Prostate-specific antigen (PSA) testing for early prostate cancer detection can be low-value when harms outweigh benefits and guidelines are not followed.
  • Identifying factors influencing PSA testing in low-value situations is crucial for optimizing screening practices.

Purpose of the Study:

  • To identify patient and provider factors associated with prostate-specific antigen (PSA) testing in low-value settings.
  • To analyze trends in PSA testing over time, differentiating between low-value and appropriate testing scenarios.

Main Methods:

  • Retrospective cohort study utilizing electronic health record data from 1,738,021 health system encounters in the United States (2011-2018).
  • Logistic generalized estimating equation models were employed to examine patient factors (age, comorbidities, family history, race, prior PSA results) and provider factors (gender, specialty, graduation year, medical school rank).

Main Results:

  • Comorbid illness and no prior PSA testing decreased the likelihood of low-value testing, while family history and high prior PSA results increased it.
  • Men aged 55-65 years had the highest risk for PSA testing in low-value situations. Urologists were most likely to perform low-value PSA testing.
  • Internal medicine physicians were more likely to order PSA tests in low-value situations but significantly more likely to order them appropriately. Overall PSA testing decreased since 2011.

Conclusions:

  • Patient factors such as comorbid illness and family history, along with provider specialty, significantly influence PSA testing in low-value settings.
  • The study highlights that men in the age group most commonly recommended for screening are also at the highest risk for receiving low-value PSA testing.
  • While some factors (e.g., comorbidities) may reduce low-value testing, others (e.g., family history) may inadvertently encourage it, necessitating careful consideration of testing indications.