Variation Among Primary Care Physicians in Prostate-Specific Antigen Screening of Older Men

BackgroundIn 2008, the United States Preventive Services Task Force recommended against prostate specific antigen (PSA) testing for cancer screening in men age 75+.PurposeTo assess PSA screening by primary care physicians (PCPs) before and after recommendations.MethodsIn 2013, this retrospective cohort study analyzed PCPs in Texas with 20+ male patients aged 75+ in both 2007 and 2010, with Parts A and B Medicare. The main outcome was percent of PCP’s male patients 75+ who received PSA testing ordered by the PCP in 2007 and 2010, with no recent symptoms suggestive of prostate cancer.ResultsIn both 2007 and 2010, 1,083 PCPs cared for at least 20 men aged 75 or older. The rate of PSA screening ordered by PCPs was 33.2% in 2007 and 30.6% in 2010. In multilevel analyses controlling for patient characteristics, the variation in PSA screening attributable to the PCP (intraclass correlation coefficient) increased from 23% in 2007 to 26% in 2010, p<0.001. Men with PCPs older than age 60 had 9% lower odds (95% CI, 1–17%) in 2010 compared to 2007 of receiving a PSA test, vs. a 4% increase (95% CI, 4% decrease to 12% increase) in men with PCPs aged 50 or younger. Patients with Board Certified PCPs had a 12% lower odds (95% CI, 8% to 16%) from 2007 to 2010, vs. 2% increase (95% CI 11% decrease to 18% increase) in men with PCPs without board certification.ConclusionsThe USPSTF recommendation did not increase consensus among PCPs regarding PSA screening of older men.

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“…Given the variation among PCPs,[10] 20 patients are sufficient to provide testing estimates with a reliability of >0.85 [19].…”

Section: Methodsmentioning

confidence: 99%

Is Anyone Listening? Variation in PSA Screening among Providers for Men 75+ before and after United States Preventive Services Task Force Recommendations against It: A Retrospective Cohort Study

Goodwin¹,

Jaramillo

Yang

et al. 2014

PLoS ONE

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“…44,45 While Blacks had less severe disease characteristics than nHWs, the exclusion of patients who refused or were not offered treatment may have introduced a bias by selecting only the healthiest Blacks for surgery. Although evidence for provider-specific screening and treatment recommendation disparities exist in PCa 46,47 , this issue was outside the scope of this study. However, the contingent provider-specific selection bias would lead to selection of surgical patients with favorable unmeasured disease characteristics such as tumor volume, PSA, and number of positive cores.…”

Section: Commentmentioning

confidence: 96%

Racial Differences in the Surgical Care of Medicare Beneficiaries With Localized Prostate Cancer

et al. 2016

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Importance There is extensive evidence suggesting that Black men with localized prostate cancer (PCa) have worse cancer-specific mortality compared to their non-Hispanic White (nHW) counterparts. Objective To evaluate racial disparities in the use, quality of care, and outcomes of radical prostatectomy (RP) in elderly men with non-metastatic PCa. Design Inclusion of patients with localized PCa who underwent RP within the first year of PCa diagnosis in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database between 1991 and 2009. Setting Retrospective analysis of outcomes stratified according to race (Black vs. nHW). Participants 2,020 (7.6%) Black and 24,462 (92.4%) nHW elderly men with localized PCa who underwent RP. Main Outcomes and Measures Process of care (i.e. time to treatment, lymph node dissection), as well as outcome measures (i.e. complications, emergency department visits, readmissions, PCa-specific and all-cause mortality, costs) were evaluated using Cox proportional hazards regression. Multivariable conditional logistic regression and quantile regression were used to study the association of racial disparities with process of care and outcome measures. Results 59.4% of Blacks vs. 69.5% of nHWs underwent RP within 90 days (p<.001); the top 50% of Blacks had an 8-day treatment delay compared to nHW (p<.001). Blacks were less likely to undergo lymph node dissection and to receive blood transfusions, but more likely to experience postoperative complications, subsequent emergency department visits, and readmissions (all p<.05). The surgical treatment of Black patients was associated with a higher incremental annual cost (top 50% spent $1185.5 more). There was no difference in PCa-specific mortality (p=.16) or all-cause mortality (p=.64) between Black and nHW men. Conclusions and Relevance Blacks treated with RP for localized PCa are more likely to experience adverse events and incur higher costs compared to nHW men, however this does not translate into a difference in PCa-specific or all-cause mortality.

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“…A PSA screening was identified as a PSA test (carrier files with CPT code 84153 and Healthcare Common Procedural Coding System [HCPCS] code G0103) for a man who had no prostate-related diagnosis within the prior 3 years and no symptoms associated with prostate cancer (e.g., hematuria, weight loss, urinary obstruction) within the previous 3 months. 17,18 Patient Characteristics. Data regarding age, sex, race/ethnicity (white, black, or other), Medicaid eligibility (yes/no), and the Elixhauser comorbidities 19 were obtained from the Medicare files.…”

Section: Study Populationmentioning

confidence: 99%

Receipt of Cancer Screening Is a Predictor of Life Expectancy

Goodwin

Sheffield

et al. 2016

J GEN INTERN MED

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Variation Among Primary Care Physicians in Prostate-Specific Antigen Screening of Older Men

Cited by 31 publications

References 7 publications

Is Anyone Listening? Variation in PSA Screening among Providers for Men 75+ before and after United States Preventive Services Task Force Recommendations against It: A Retrospective Cohort Study

Is Anyone Listening? Variation in PSA Screening among Providers for Men 75+ before and after United States Preventive Services Task Force Recommendations against It: A Retrospective Cohort Study

Racial Differences in the Surgical Care of Medicare Beneficiaries With Localized Prostate Cancer

Receipt of Cancer Screening Is a Predictor of Life Expectancy

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