BACKGROUND: Prostate-specific antigen (PSA) testing for early detection of prostate cancer is low-value when it is not indicated by guidelines and the harms outweigh the benefits. In this retrospective cohort study, we identify provider and patient factors associated with PSA testing, particularly in situations where testing would be low-value. METHODS: We used electronic health record data from 2011 to 2018 representing 1,738,021 health system encounters in the United States. Using logistic generalized estimating equation models, we examined patient factors (age, comorbid illness, family history, race and prior PSA results), provider factors (gender, specialty, graduation year and medical school rank), and overall time trends associated with PSA testing in low-value and appropriate settings. RESULTS: Comorbid illness (odds ratio (OR) 0.0 for 3+ conditions vs none) and no prior PSA testing (OR 0.2) were associated with a lower likelihood of PSA testing in low-value situations, while family history of prostate cancer (OR 1.6) and high prior PSA test results (OR 2.2 for PSA > 6 vs 0-1) were associated with a greater likelihood. Men aged 55-65 years were at greatest risk for PSA testing in low-value situations. The provider factor associated with PSA testing in low-value situations was specialty, with urologists being most likely (OR 2.3 versus advanced practice providers). Internal medicine physicians were more likely to perform PSA testing during low-value situations (OR 1.3 versus advanced practice providers) but much more likely to order a PSA test where appropriate (OR 2.2). All PSA testing decreased since 2011. CONCLUSION: We identified several patient and provider factors associated with PSA testing in low-value settings. Some aspects suggest attention to relevant factors for PSA testing in low-value settings (e.g. comorbid illness), while others may encourage PSA testing in low-value settings (e.g. family history). The greatest likelihood of PSA testing in low-value settings is among men within the age range most commonly recommended by guidelines.
BACKGROUND:Prostate-specific antigen (PSA) testing for early detection of prostate cancer is low-value when it is not indicated by guidelines and the harms outweigh the benefits. In this retrospective cohort study, we identify provider and patient factors associated with PSA testing, particularly in situations where testing would be low-value. METHODS: We used electronic health record data from 2011 to 2018 representing 1,738,021 health system encounters in the United States. Using logistic generalized estimating equation models, we examined patient factors (age, comorbid illness, family history, race and prior PSA results), provider factors (gender, specialty, graduation year and medical school rank), and overall time trends associated with PSA testing in low-value and appropriate settings. RESULTS: Comorbid illness (odds ratio (OR) 0.0 for 3+ conditions vs none) and no prior PSA testing (OR 0.2) were associated with a lower likelihood of PSA testing in low-value situations, while family history of prostate cancer (OR 1.6) and high prior PSA test results (OR 2.2 for PSA > 6 vs 0-1) were associated with a greater likelihood. Men aged 55-65 years were at greatest risk for PSA testing in low-value situations. The provider factor associated with PSA testing in low-value situations was specialty, with urologists being most likely (OR 2.3 versus advanced practice providers). Internal medicine physicians were more likely to perform PSA testing during low-value situations (OR 1.3 versus advanced practice providers) but much more likely to order a PSA test where appropriate (OR 2.2). All PSA testing decreased since 2011. CONCLUSION: We identified several patient and provider factors associated with PSA testing in low-value settings. Some aspects suggest attention to relevant factors for PSA testing in low-value settings (e.g. comorbid illness), while others may encourage PSA testing in low-value settings (e.g. family history). The greatest likelihood of PSA testing in low-value settings is among men within the age range most commonly recommended by guidelines.
Authors: Ian M Thompson; Donna Pauler Ankerst; Chen Chi; Phyllis J Goodman; Catherine M Tangen; M Scott Lucia; Ziding Feng; Howard L Parnes; Charles A Coltman Journal: J Natl Cancer Inst Date: 2006-04-19 Impact factor: 13.506
Authors: Peter R Carroll; J Kellogg Parsons; Gerald Andriole; Robert R Bahnson; Erik P Castle; William J Catalona; Douglas M Dahl; John W Davis; Jonathan I Epstein; Ruth B Etzioni; Thomas Farrington; George P Hemstreet; Mark H Kawachi; Simon Kim; Paul H Lange; Kevin R Loughlin; William Lowrance; Paul Maroni; James Mohler; Todd M Morgan; Kelvin A Moses; Robert B Nadler; Michael Poch; Chuck Scales; Terrence M Shaneyfelt; Marc C Smaldone; Geoffrey Sonn; Preston Sprenkle; Andrew J Vickers; Robert Wake; Dorothy A Shead; Deborah A Freedman-Cass Journal: J Natl Compr Canc Netw Date: 2016-05 Impact factor: 11.908
Authors: Andrew M D Wolf; Richard C Wender; Ruth B Etzioni; Ian M Thompson; Anthony V D'Amico; Robert J Volk; Durado D Brooks; Chiranjeev Dash; Idris Guessous; Kimberly Andrews; Carol DeSantis; Robert A Smith Journal: CA Cancer J Clin Date: 2010-03-03 Impact factor: 508.702
Authors: Heidi A Hanson; Christopher Martin; Brock O'Neil; Claire L Leiser; Erik N Mayer; Ken R Smith; William T Lowrance Journal: J Urol Date: 2019-06-27 Impact factor: 7.450
Authors: Fritz H Schröder; Jonas Hugosson; Monique J Roobol; Teuvo L J Tammela; Marco Zappa; Vera Nelen; Maciej Kwiatkowski; Marcos Lujan; Liisa Määttänen; Hans Lilja; Louis J Denis; Franz Recker; Alvaro Paez; Chris H Bangma; Sigrid Carlsson; Donella Puliti; Arnauld Villers; Xavier Rebillard; Matti Hakama; Ulf-Hakan Stenman; Paula Kujala; Kimmo Taari; Gunnar Aus; Andreas Huber; Theo H van der Kwast; Ron H N van Schaik; Harry J de Koning; Sue M Moss; Anssi Auvinen Journal: Lancet Date: 2014-08-06 Impact factor: 79.321
Authors: Trevor C Hunt; Jacob P Ambrose; Benjamin Haaland; Kensaku Kawamoto; Christopher B Dechet; William T Lowrance; Heidi A Hanson; Brock B O'Neil Journal: Cancer Date: 2021-05-27 Impact factor: 6.860