Urology Referrals for Elevated PSA Unchanged

New study examined the effect of a U.S. Preventive Services Task Force 2012 recommendation against routine PSA screening.

In the year following the USPSTF statement against routine PSA screening, the number of patients referred to urologists for a newly elevated PSA level did not change.
In the year following the USPSTF statement against routine PSA screening, the number of patients referred to urologists for a newly elevated PSA level did not change.

The 2012 United States Preventive Services Task Force (USPSTF) grade D recommendation against PSA screening has not affected the number of patients referred to urologists for a newly elevated PSA level at a New York cancer center, according to researchers.

The characteristics of the patients who were referred also remained essentially unchanged in the year following, with lower-risk patients still referred.

Urologists at Columbia University College of Physicians and Surgeons, however, did appear more discerning about whether to biopsy. They ordered more urinary PCA3 tests and repeat PSA tests and recommended fewer biopsies at the initial visit.

“Our findings may reflect an effort by urologists to limit unnecessary biopsies,” wrote study author Tomy Y. Perez, MD, and colleagues in Urology. “Despite this effort, the proportion of men who ultimately received a prostate biopsy after being referred to a urologist for elevated PSA level was unchanged.”

The researchers examined clinical and management factors for 201 men seen by urologists at the center during the year prior to the USPSTF statement (circa June 2012) and compared them with 212 men treated in the year afterward. Both groups were alike in age, race, prostate cancer (PCa) history, PSA values and digital rectal examination findings.

Patients seen post-USPSTF were more likely to receive PCA3 testing (27% vs. 11%; P <.01) and repeat PSA testing (82% vs. 72%; P =.02) at the initial visit and less likely to undergo immediate biopsy (16% vs. 24%; P =.03).

The proportion of patients ultimately receiving a biopsy was the same. The groups were also similar in the percentage of positive biopsies, Gleason score and D'Amico risk group.

African-American race and family history of PCa, long considered risk factors, were predictors for receiving a biopsy in the post-USPSTF group but not the pre-USPSTF group.

If confirmed, study findings “would imply that urologists began using a broader range of information in their biopsy decisions.” This increased selectivity did not, however, improve PCa detection, the researchers wrote.

Source

  1. Perez, TY et al. Urology. 2014; doi: dx.doi.org/10.1016/j.urology.2014.07.072.
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