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Related Experiment Videos

Prostate-specific antigen testing practices and outcomes

R M Hoffman1, P Blume, F Gilliland

  • 1Department of Medicine, Albuquerque Veterans Affairs Medical Center, University of New Mexico, 87108, USA.

Journal of General Internal Medicine
|March 21, 1998
PubMed
Summary
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Prostate-specific antigen (PSA) testing is common in primary care but often outside guidelines. Older men with elevated PSA levels frequently do not complete necessary diagnostic workups, indicating a need for better adherence to screening protocols.

Area of Science:

  • Urology
  • Primary Care Medicine
  • Oncology

Background:

  • Prostate-specific antigen (PSA) testing is a widely used tool for prostate cancer screening.
  • Practices surrounding PSA testing and its outcomes in primary care settings require characterization.

Purpose of the Study:

  • To analyze prostate-specific antigen (PSA) testing patterns within a hospital-based primary care clinic.
  • To evaluate the downstream effects of PSA testing, including referrals, biopsies, cancer detection, and treatment initiation.

Main Methods:

  • A retrospective cohort study design was employed.
  • Data were extracted from computerized Department of Veterans Affairs (VA) files and the New Mexico Surveillance, Epidemiology, and End Results (SEER) tumor registry.
  • The study included 1,448 men without cancer undergoing PSA testing in 1993, with follow-up through 1994.

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Main Results:

  • Twenty-one percent of eligible men aged 40+ were tested for PSA, with a notable proportion (58) aged 75 or older.
  • Retesting rates and intervals varied, with 40.0% retested and 25.6% of initial retests occurring within 6 months.
  • Among men with PSA values >= 4.0 ng/mL, 86.0% were referred to urology, and 46.1% underwent biopsy; however, older men (>=75) were less likely to complete biopsies.
  • Forty cancers were diagnosed, yielding a detection rate of 2.8%.

Conclusions:

  • Primary care providers frequently order PSA tests, but adherence to recommended age ranges and screening intervals is inconsistent.
  • Older patients with elevated PSA results often do not complete the full diagnostic workup, including biopsies.
  • Improved adherence to established PSA screening guidelines could optimize testing frequency and reduce unnecessary urology referrals.