Journal article
What Happens After an Elevated PSA Test: The Experience of 13,591 Veterans
Journal of general internal medicine : JGIM, Vol.25(11), pp.1205-1210
11/2010
DOI: 10.1007/s11606-010-1468-9
PMCID: PMC2947635
PMID: 20697965
Abstract
Background: The occurrence and timing of prostate biopsy following an elevated prostate-specific antigen (PSA) test varied considerably in randomized screening trials.
Objective: Examine practice patterns in routine clinical care in response to an elevated PSA test (≥4 ng/μl) and determine whether time to biopsy was associated with cancer stage at diagnosis.
Design: Retrospective cohort study.
Participants: All veterans (n=13,591) in the Pacific Northwest VA Network with a PSA ≥4 ng/μl between 1998 and 2006 and no previous elevated PSA tests or prostate biopsy.
Main measures: We assessed follow-up care including additional PSA testing, urology consults, and biopsies. We compared stage at diagnosis for men who were biopsied within 24 months vs. those men biopsied and diagnosed>24 months after the elevated PSA test.
Key results: Two-thirds of patients received follow-up evaluation within 24 months of the elevated PSA test: 32.8% of men underwent a biopsy, 15.5% attended a urology visit but were not biopsied, and 18.8% had a subsequent normal PSA test. Younger age, higher PSA levels, more prior PSA tests, no co-payment requirements, existing urologic conditions, low body mass index, and low comorbidity scores were associated with more complete follow-up. Among men who underwent radical prostatectomy, a delayed diagnosis was not significantly associated with having a pathologically advanced-stage cancer (T3/T4), although we found an increased likelihood of presenting with stage T2C relative to stage T2A or T2B cancer.
Conclusions: Follow-up after an elevated PSA test is highly variable with more than a third of men receiving care that could be considered incomplete. A delayed diagnosis was not associated with poorer prognosis.
Details
- Title: Subtitle
- What Happens After an Elevated PSA Test: The Experience of 13,591 Veterans
- Creators
- Steven B Zeliadt - VA Health Services Research & Development Service, Department of Veterans Affairs Medical Center, Seattle, WA USARichard M Hoffman - Medicine Service, Department of Veterans Affairs Medical Center, Albuquerque, NM; Department of Medicine, University of New Mexico, Albuquerque, NM USARuth Etzioni - Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA USAVan Anh T Ginger - Department of Urology, University of Washington, Seattle, WA USADaniel W Lin - Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA USA
- Resource Type
- Journal article
- Publication Details
- Journal of general internal medicine : JGIM, Vol.25(11), pp.1205-1210
- Publisher
- Springer-Verlag
- DOI
- 10.1007/s11606-010-1468-9
- PMID
- 20697965
- PMCID
- PMC2947635
- ISSN
- 0884-8734
- eISSN
- 1525-1497
- Language
- English
- Date published
- 11/2010
- Academic Unit
- Epidemiology; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984094576102771
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