Primary-Care Physicians Drive PSA Testing for Older Men
Although no organization recommends PSA screening for men older aged 75 years and older, a large analysis of Medicare data revealed that 41% of such patients in Texas did undergo PSA screening, largely due to decisions made by the particular primary-care physician (PCP).
As Elizabeth Jaramillo, MD, of the University of Texas Medical Branch in Galveston, and fellow investigators explained in The Journal of the American Medical Association (2013;310:1622-1624), they had hypothesized that PCPs would vary substantially in PSA screening rates and that much of the variance in whether an older man received a PSA test would depend on which PCP he saw. The group used complete Medicare Part A and Part B data for Texas to select 1,963 PCPs whose patient panels included at least 20 men aged 75 years and older without a prior diagnosis of prostate cancer.
The 61,351 patient records yielded by the search indicated that overall, 41.1% of the men received PSA screening and 28.8% received PSA screening ordered by their PCPs. Both rates declined with patient age.
Dr. Jaramillo's group uncovered a 10-fold difference in rates between the highest and the lowest deciles of PCPs. In addition, which PCP a man saw accounted for approximately seven times more of the variance in PSA screening than did such patient characteristics as age, ethnicity, and location.
The authors pointed out that more research is needed to understand why some PCPs are more likely than others to order PSA screening for men aged 75 years and older, despite the lack of recommendations for such testing.