Elevated PSA Often Meets with Delayed Response
Delayed clinician response to a patient's abnormal PSA level occurs in about 23% of cases, which may be more common than is generally appreciated, according to researchers.
Terry L. Wahls, MD, MBA, associate chief of staff at the Iowa City Veterans Affairs Medical Center in Iowa, and colleagues studied 327 men who had an abnormal PSA value (4 ng/mL or higher) prior to diagnosis of prostate cancer. At first PSA elevation, the median age of the patient group was 64 years.
Of the 327 men, 253 (77.4%) had a timely response (30 days or less) to an abnormal PSA value documented in the medical record. The remaining 74 patients (22.6%) had a delayed response (more than 30 days). Clinician response to an abnormal PSA value was 31-180 days for 23 patients (7%), 181-360 days for 24 patients (7.3%), and more than 360 days for 27 patients (8.3%), the researchers reported in Mayo Clinic Proceedings (2008;83:439-448).
The patients had a median PSA level of 5.8 ng/mL. The median PSA velocity at elevation was 1.5 ng/mL annually for the 116 men for whom the velocity could be calculated. The presence of urologic symptoms, ab-normal digital rectal examination findings, higher PSA values, and higher PSA velocity predicted timely clinical response.
Those with a timely response to an abnormal PSA value had 422 fewer days to prostate gland biopsy.
“These data add to a growing body of literature on diagnostic error associated with missed results, which documents that such errors occur with predictable frequency and involve multiple types of diagnostic studies and clinical settings,” the authors wrote.
They concluded that the “absence of, or a delayed response to, abnormal results from cancer screening tests is an important source of diagnostic errors.”