BACKGROUND: The occurrence and timing of prostate biopsy following an elevated prostate-specific antigen (PSA) test varied considerably in randomized screening trials. OBJECTIVE: Examine practice patterns in routine clinical care in response to an elevated PSA test (≥4 ng/μl) and determine whether time to biopsy was associated with cancer stage at diagnosis. DESIGN: Retrospective cohort study. PARTICIPANTS: All veterans (n=13,591) in the Pacific Northwest VA Network with a PSA ≥4 ng/μl between 1998 and 2006 and no previous elevated PSA tests or prostate biopsy. MAIN MEASURES: We assessed follow-up care including additional PSA testing, urology consults, and biopsies. We compared stage at diagnosis for men who were biopsied within 24 months vs. those men biopsied and diagnosed>24 months after the elevated PSA test. KEY RESULTS: Two-thirds of patients received follow-up evaluation within 24 months of the elevated PSA test: 32.8% of men underwent a biopsy, 15.5% attended a urology visit but were not biopsied, and 18.8% had a subsequent normal PSA test. Younger age, higher PSA levels, more prior PSA tests, no co-payment requirements, existing urologic conditions, low body mass index, and low comorbidity scores were associated with more complete follow-up. Among men who underwent radical prostatectomy, a delayed diagnosis was not significantly associated with having a pathologically advanced-stage cancer (T3/T4), although we found an increased likelihood of presenting with stage T2C relative to stage T2A or T2B cancer. CONCLUSIONS: Follow-up after an elevated PSA test is highly variable with more than a third of men receiving care that could be considered incomplete. A delayed diagnosis was not associated with poorer prognosis.
BACKGROUND: The occurrence and timing of prostate biopsy following an elevated prostate-specific antigen (PSA) test varied considerably in randomized screening trials. OBJECTIVE: Examine practice patterns in routine clinical care in response to an elevated PSA test (≥4 ng/μl) and determine whether time to biopsy was associated with cancer stage at diagnosis. DESIGN: Retrospective cohort study. PARTICIPANTS: All veterans (n=13,591) in the Pacific Northwest VA Network with a PSA ≥4 ng/μl between 1998 and 2006 and no previous elevated PSA tests or prostate biopsy. MAIN MEASURES: We assessed follow-up care including additional PSA testing, urology consults, and biopsies. We compared stage at diagnosis for men who were biopsied within 24 months vs. those men biopsied and diagnosed>24 months after the elevated PSA test. KEY RESULTS: Two-thirds of patients received follow-up evaluation within 24 months of the elevated PSA test: 32.8% of men underwent a biopsy, 15.5% attended a urology visit but were not biopsied, and 18.8% had a subsequent normal PSA test. Younger age, higher PSA levels, more prior PSA tests, no co-payment requirements, existing urologic conditions, low body mass index, and low comorbidity scores were associated with more complete follow-up. Among men who underwent radical prostatectomy, a delayed diagnosis was not significantly associated with having a pathologically advanced-stage cancer (T3/T4), although we found an increased likelihood of presenting with stage T2C relative to stage T2A or T2B cancer. CONCLUSIONS: Follow-up after an elevated PSA test is highly variable with more than a third of men receiving care that could be considered incomplete. A delayed diagnosis was not associated with poorer prognosis.
Authors: J J Tosoian; R Alam; C Gergis; A Narang; N Radwan; S Robertson; T McNutt; A E Ross; D Y Song; T L DeWeese; P T Tran; P C Walsh Journal: Prostate Cancer Prostatic Dis Date: 2017-01-03 Impact factor: 5.554
Authors: Omotola S Ashorobi; Jacqueline Frost; Xuemei Wang; Pamela Roberson; E Lin; Robert J Volk; David S Lopez; Lovell A Jones; Curtis A Pettaway Journal: Am J Mens Health Date: 2016-07-08
Authors: Danil V Makarov; Elaine Y C Hu; Dawn Walter; R Scott Braithwaite; Scott Sherman; Heather T Gold; Xiao-Hua Andrew Zhou; Cary P Gross; Steven B Zeliadt Journal: Health Serv Res Date: 2015-09-30 Impact factor: 3.402
Authors: Kailash C Chadha; Austin Miller; Bindukumar B Nair; Stanley A Schwartz; Donald L Trump; Willie Underwood Journal: Clin Cancer Investig J Date: 2014
Authors: Steven B Zeliadt; Diana S M Buist; Robert J Reid; David C Grossman; Jian Ma; Ruth Etzioni Journal: Am J Prev Med Date: 2012-01 Impact factor: 5.043
Authors: J L Wright; S R Plymate; M P Porter; J L Gore; D W Lin; E Hu; S B Zeliadt Journal: Prostate Cancer Prostatic Dis Date: 2013-03-05 Impact factor: 5.554
Authors: Jon C Tilburt; Kathryn Koller; James J Tiesinga; Robin T Wilson; Anne C Trinh; Kristin Hill; Ingrid J Hall; Judith Lee Smith; Donatus U Ekwueme; Wesley O Petersen Journal: J Health Care Poor Underserved Date: 2013-11