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PSA testing for older patients varied greatly by primary care physician
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The rate at which primary care physicians order PSA screening for older patients varies considerably, as researchers calculated a 10-fold difference in screening rates between the highest and lowest decile of providers.
Patients’ primary care physicians (PCP) played a greater role in the decision to undergo PSA screening than age, ethnicity and comorbidities, results showed.
“Our results suggest that a major reason for the continued high PSA rate is decision-making by the physicians,” researcher James S. Goodwin, MD, director of the University of Texas Medical Branch’s Sealy Center on Aging in Galveston, said in a press release. “It is clear that some of the overuse is because of preferences of individual patients, but the conclusion of our results is that much more is coming from their PCP.”
Goodwin and colleagues used Medicare Part A and Part B data to evaluate 1,963 PCPs in Texas who saw a combined 61,351 men aged 75 or older. Each PCP saw at least 20 men of that age.
After adjusting for patient characteristics, researchers determined 41.1% of men included in the analysis underwent PSA screening in 2010, and 28.8% did so at the recommendation of their PCP.
Researchers determined 474 PCPs (24.2%) ordered significantly more PSA screening than the mean rate for the entire physician cohort.
Researchers calculated a 0.27 intraclass correlation coefficient (ICC), indicating that 27% of PSA variance could be traced to PCPs. Patient characteristics such as age and comorbidity accounted for 3.7% of the variance.
This variability was unique for prostate cancer screening and was not observed in patients who underwent mammography (ICC=0.10) and colorectal cancer screening (ICC=0.09), the researchers wrote.
In 2012, the US Preventive Services Task Force recommended against routine PSA screening in men aged 75 years or older. No other medical organization recommends prostate cancer screening for that age group.
“Overtesting can create harms, including overdiagnosis,” researcher Elizabeth Jaramillo, MD, instructor of internal medicine-geriatrics at the University of Texas Medical Branch, said in the press release. “The vast majority of prostate cancers are so slow growing that an elderly man is much more likely to die of another condition in his lifetime than die from cancer.”
Disclosure: The researchers report no relevant financial disclosures.
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