Yu-Kuan Lin1, Lori Gettle, Jay D Raman. 1. Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033-0850, USA.
Abstract
OBJECTIVES: To determine prostate-specific antigen (PSA) management patterns of nonurologist providers. Urologists are involved in the management of men's prostate health. In practice, nonurology providers are more likely to see patients in the screening setting. METHODS: Survey questions were designed to evaluate a nonurologist's approach to PSA screening. The survey instrument was distributed to physicians and physician extenders in fields of internal medicine and family practice at a tertiary-care medical center. RESULTS: Of 116 nonurologist providers, 86 (74%) completed the survey. There was variability with respect to the age at which to screen the index patient (asymptomatic white man without a prostate cancer family history): 16% initiated screening at 41-50 years of age and 77% at 51-60 years. Additionally, heterogeneity was found with regard to categorizing an elevated PSA level, with 62% of providers using an absolute PSA cutoff of >4 ng/mL and only 27% citing age-specific criteria. When diagnosing an asymptomatic man with an elevated PSA level, most providers will recheck PSA in 3-6 months (38%) or initiate a trial of empiric antibiotics (30%). Only a smaller fraction will refer the patient to a urologist (21%) or repeat PSA test immediately within 2-4 weeks (11%). CONCLUSIONS: We noted variability in PSA management patterns by nonurologists. Only 27% of providers used age-specific criteria, and almost 70% managed an elevated value by rechecking at a delayed interval or initiating a trial of antibiotics. This suggests that education might be necessary to create uniformity in PSA screening amongst nonurologists.
OBJECTIVES: To determine prostate-specific antigen (PSA) management patterns of nonurologist providers. Urologists are involved in the management of men's prostate health. In practice, nonurology providers are more likely to see patients in the screening setting. METHODS: Survey questions were designed to evaluate a nonurologist's approach to PSA screening. The survey instrument was distributed to physicians and physician extenders in fields of internal medicine and family practice at a tertiary-care medical center. RESULTS: Of 116 nonurologist providers, 86 (74%) completed the survey. There was variability with respect to the age at which to screen the index patient (asymptomatic white man without a prostate cancer family history): 16% initiated screening at 41-50 years of age and 77% at 51-60 years. Additionally, heterogeneity was found with regard to categorizing an elevated PSA level, with 62% of providers using an absolute PSA cutoff of >4 ng/mL and only 27% citing age-specific criteria. When diagnosing an asymptomatic man with an elevated PSA level, most providers will recheck PSA in 3-6 months (38%) or initiate a trial of empiric antibiotics (30%). Only a smaller fraction will refer the patient to a urologist (21%) or repeat PSA test immediately within 2-4 weeks (11%). CONCLUSIONS: We noted variability in PSA management patterns by nonurologists. Only 27% of providers used age-specific criteria, and almost 70% managed an elevated value by rechecking at a delayed interval or initiating a trial of antibiotics. This suggests that education might be necessary to create uniformity in PSA screening amongst nonurologists.