Prostate-specific antigen testing practices and outcomes
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
OBJECTIVES: To characterize prostate-specific antigen (PSA) testing practices in a hospital-based primary care clinic, and to determine the outcomes of PSA testing, including urology referrals, biopsies, cancers detected, and cancer treatments.
DESIGN: Retrospective cohort study. Data were obtained from computerized Department of Veterans Affairs (VA) files and the statewide New Mexico Surveillance, Epidemiology, and End Results (SEER) tumor registry.
SETTING: Primary care clinics in a university-affiliated VA Medical Center.
PATIENTS: Subjects were 1,448 men without cancer undergoing PSA testing in 1993 with follow-up through 1994.
MAIN RESULTS: Twenty-one percent of clinic enrollees at least 40 years of age were tested with PSA, including 58 who were 75 years of age or older. By the end of 1994, 40.0% (95% confidence interval [CI] 37.2%, 42.8%) were retested; 25.6% (95% CI 21.7%, 29.5%) of initial retesting occurred within 6 months. Overall, 20.7% (95% CI 18.9%, 22.5%) of PSA tests in the cohort were for men aged 75 years or older and were repeated within 6 months. Among the 193 subjects with PSA values ≥ 4.0 ng/mL, 86.0% (95% CI 81.1%, 90.9%) were followed-up in urology clinic, and 46.1% (95% CI 39.1%, 53.1%) underwent biopsy. Only 11 of 51 men aged 75 years or older who were referred to urologists for an elevated PSA underwent biopsy. Forty cancers were diagnosed—a detection rate of 2.8% (95% CI 2.0%, 3.6%). Of these, 28 were organconfined, 7 had regional invasion, and 3 had distant metastases.
CONCLUSIONS: Primary care providers frequently ordered PSA tests, but a substantial proportion of testing occurred outside recommended age ranges and screening intervals. Older patients with elevated PSA values often did not complete diagnostic workups. Better adherence to screening guidelines may limit the number of both PSA tests and urology referrals.
- U.S. Preventive Services Task Force. Guide to Clinical Preventive Services. Baltimore, Md: Williams & Wilkins; 1996;119–34.
- American College of Physicians. Clinical Guideline: Part III. Screening for prostate cancer. Ann Intern Med. 1997;126:480–4.
- PDQ (Physician Data Query) [database online]. Screening for prostate cancer. Bethesda, Md: National Cancer Institute; 1984, updated July 1997. Available from National Cancer Institute; National Library of Medicine, Bethesda, Md; CDP Technologies, Inc., New York, NY; Lexis-Nexis, Miamisburg, Ohio.
- Canadian Task Force on the Periodic Health Examination. Periodic health examination, 1991 update: 3. Secondary prevention of prostate cancer. Can Med Assoc J. 1991;145:413–28.
- American Urological Association. Early detection of prostate cancer and use of transrectal ultrasound. In: American Urological Association 1992 Policy Statement Book. Baltimore, Md: Williams & Wilkins; 1992.
- Mettlin C, Jones G, Averette H, Gusberg SB, Murphy GP. Defining and updating the American Cancer Society guidelines for the cancer related checkup: prostate and endometrial cancers. CA Cancer J Clin. 1993;43:42–6. CrossRef
- Oesterling JE. Prostate-specific antigen. Improving its ability to diagnose early prostate cancer. JAMA. 1992;267:2236–8. CrossRef
- Rosen MA. Impact of prostate-specific antigen screening on the natural history of prostate cancer. Urology. 1995;46:757–68. CrossRef
- Key CR. Cancer incidence and mortality in New Mexico, 1973–77. In: Young JJL, Percy CL, Asire AJ, eds. Surveillance, Epidemiology and End Results (SEER): Incidence and Mortality Data, 1973–77. Washington, DC: Government Printing Office; 1981:489–595.
- Zippin C, Lum D, Hankey BF. Completeness of hospital cancer case reporting from the SEER program of the National Cancer Institute. Cancer. 1995;76:2343–50. CrossRef
- Rosner B. Fundamentals of Biostatistics. Boston, Mass: PWS Publishers; 1986:165–9.
- Fleiss JL. Statistical Methods for Rates and Proportions. New York, NY: John Wiley & Sons; 1981:143–6.
- Oesterling JE, Jacobsen SJ, Chute CG, et al. Serum prostatespecific antigen in a community-based population of healthy men. Establishment of age-specific reference ranges. JAMA. 1993;270:860–4. CrossRef
- Potosky AL, Miller BA, Albertsen PC, Kramer BS. The role of increasing detection in the rising incidence of prostate cancer. JAMA. 1995;273:548–52. CrossRef
- Williams RB, Boles M, Johnson RE. Use of prostate-specific antigen for prostate cancer screening in primary care practice. Arch Fam Med. 1995;4:311–5. CrossRef
- Jacobsen SJ, Katusic SK, Bergstralh EJ, et al. Incidence of prostate cancer diagnosis in the eras before and after serum prostate-specific antigen testing. JAMA. 1995;274:1445–9. CrossRef
- Cupp MR, Oesterling JE. Prostate-specific antigen, digital rectal examination, and transrectal ultrasonography: their roles in diagnosing early prostate cancer. Mayo Clin Proc. 1993;68:297–306.
- Barry MJ, Roberts RG, Oesterling JE, McNaughton Collins MF, Fowler FJ. Differences in how primary care phsicians and urologists approach early detection of prostate cancer. J Gen Intern Med. 1996;11(suppl):62. Abstract.
- Catalona WJ, Richie JP, Dekernion JB, et al. Comparison of prostate specific antigen concentration versus prostate specific antigen density in the early detection of prostate cancer: receiver operating characteristic curves. J Urol. 1994;152:2031–6.
- Brawer MK, Chetner MP, Beatie J, Buchner DM, Vessela RL, Lange PH. Screening for prostatic carcinoma with prostate specific antigen. J Urol. 1992;147:841–5.
- Mettlin C, Murphy GP, Lee F, et al. Characteristics of prostate cancers detected in a multimodality early detection program. Cancer. 1993;72:1701–8. CrossRef
- Crawford ED, DeAntoni EP, Etzioni R, et al. Serum prostatespecific antigen and digital rectal examination for early detection of prostate cancer in a national community-based program. Urology. 1996;47:863–9. CrossRef
- Cooner WH, Mosley BR, Rutherford CL, et al. Prostate cancer detection in a clinical urological practice by ultrasonography, digital rectal examination and prostate specific antigen. J Urol. 1990;143:1146–54.
- Catalona WJ, Smith DS, Ratliff TL, Basler JW. Detection of organconfined prostate cancer is increased through prostate-specific antigen-based screening. JAMA. 1993;270:948–54. CrossRef
- Prostate-specific antigen testing practices and outcomes
Journal of General Internal Medicine
Volume 13, Issue 2 , pp 106-110
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- prostate cancer
- prostate-specific antigen (PSA)
- Industry Sectors
- Author Affiliations
- 1. Department of Medicine, Albuquerque Veterans Affairs Medical Center, USA
- 2. Department of Internal Medicine, University of New Mexico, Albuquerque
- 3. Department of Pathology, Albuquerque Veterans Affairs Medical Center, USA
- 4. Department of Prevention, University of New Mexico, Albuquerque
- 5. the New Mexico Tumor Registry, USA