Article Data

  • Views 1396
  • Dowloads 127

Original Research

Open Access

Prostate Specific Antigen (PSA) testing practices in an academic healthcare organization

  • Margarita Echeverri1,*,
  • Elizabeth Yanes2
  • David Anderson3
  • Anna María Nápoles4

1Division of Clinical Services, College of Pharmacy, Xavier University of Louisiana, New Orleans, LA 70125, USA

2School of Public Health, Health Sciences Center, Louisiana State University, New Orleans, LA 70112, USA

3Department of Mathematics, Xavier University of Louisiana, New Orleans, LA 70125, USA

4Division of Intramural Research, National Institute on Minority Health and Health Disparities, Rockville, MD 20892, USA

DOI: 10.31083/j.jomh1803074 Vol.18,Issue 3,March 2022 pp.1-11

Submitted: 01 December 2021 Accepted: 21 January 2022

Published: 31 March 2022

*Corresponding Author(s): Margarita Echeverri E-mail: mechever@xula.edu

Abstract

Background: It is estimated that one out of nine men will be diagnosed with prostate cancer in their lives. However, there is so much debate about the impact of guidelines in prostate specific antigen (PSA) screening for early detection of prostate cancer. Although some studies have examined variation in PSA-based screening for prostate cancer, they have not considered the impact that the type of health insurance and clinician specialty may have in PSA-screening practices. Methods: Retrospective medical chart review of 500 male patients (40–69 years old). ANOVAS and logistic regression tested for significant differences in the variables of interest. Results: The majority (83%) of patients did not receive any type of PSA-testing during the study period. Patients of older age and those having private insurance were more likely to have a PSA-test. Of those patients who had PSA testing (n = 83), half received it for prostate cancer screening. The majority of the PSA-tests performed (n = 214) were ordered by urologists, received by White patients, and covered by private insurance. Conclusions: In this study, type of health insurance and age were associated with receipt of a PSA test, as opposed to race. Considering that male patients usually go to the urologists only when they have prostate symptoms, primary care clinicians may benefit from continued education on counseling patients, especially those who may be at elevated risk, regarding the importance of prostate health and PSA exams in general.

Keywords

prostate-specific antigen; prostate-related conditions; African Americans; health insurance; primary care physician; urologist

Cite and Share

Margarita Echeverri,Elizabeth Yanes,David Anderson,Anna María Nápoles. Prostate Specific Antigen (PSA) testing practices in an academic healthcare organization. Journal of Men's Health. 2022. 18(3);1-11.

References

[1] National Institute on Aging (NIA). Prostate Problems. 2020. Available at: https://www.nia.nih.gov/health/prostate-problems (Accessed: 9 June 2021).

[2] National Cancer Institute (NCI). Understanding Prostate Changes: A Health Guide for Men. 2011. Available at: https://www.cancer.gov/types/prostate/understanding-prostate- changes (Accessed: 9 June 2021).

[3] National Cancer Institute. Cancer stat facts: prostate cancer. 2021. Available at: https://seer.cancer.gov/statfacts/html/prost.h tml (Accessed: 9 June 2021).

[4] American Association for Cancer Research (AACR). AACR Cancer Disparities Progress Report 2020. American Associa-tion for Cancer Research: Philadelphia: 2020. Available at: http://www.CancerDisparitiesProgressReport.org/ (Accessed: 27 June 2021).

[5] Lee SH, Lee SK. Does Race/Ethnicity have a Role in a Link between Lower Urinary Track Symptoms and Metabolic Syn-drome? European Medical Journal. 2017; 2: 69–75.

[6] Hoke GP, McWilliams GW. Epidemiology of Benign Prostatic Hyperplasia and Comorbidities in Racial and Ethnic Minor-ity Populations. The American Journal of Medicine. 2008; 121: S3–S10.

[7] Kristal AR, Arnold KB, Schenk JM, Neuhouser ML, Weiss N, Goodman P, et al. Race/ethnicity, obesity, health related behav-iors and the risk of symptomatic benign prostatic hyperplasia: results from the prostate cancer prevention trial. The Journal of Urology. 2007; 177: 1395–400.

[8] Pettaway CA, Lamerato LE, Eaddy MT, Edwards JK, Hogue SL, Crane MM. Benign prostatic hyperplasia: racial differ-ences in treatment patterns and prostate cancer prevalence. BJU Interna-tional. 2011; 108: 1302–1308.

[9] Johns Hopkins Medicine. Benign Prostatic Hyperplasia (BPH). 2021. Available at: https://www.hopkinsmedicine.org/health/c onditions-and-diseases/benign-prostatic-hyperplasia-bph (Ac-cessed: 9 June 2021).

[10] Villines Z, Martinez K. Seven causes of a high PSA that are not cancer. Medical News Today. 2019. Available at: http s://www.medicalnewstoday.com/articles/319551 (Accessed: 9 June 2021).

[11] Mayo Clinic. Patient Care & Health Information: PSA test. 2019. Available at: https://www.mayoclinic.org/tests-procedure s/psa-test/about/pac-20384731 (Accessed: 3 June 2021).

[12] Wu Y, Davidian MH, DeSimone EM. Guidelines for the Treat-ment of Benign Prostatic Hyperplasia. US Pharm. 2016. Avail-able at: https://www.uspharmacist.com/article/guidelines-for - the-treatment-of-benign-prostatic-hyperplasia (Accessed: 3 June 2021).

[13] Moyer VA, U.S. Preventive Services Task Force. Screening for Prostate Cancer: U.S. Preventive Services Task Force Recom-mendation Statement. Annals of Internal Medicine. 2012; 157: 120–134.

[14] US Preventive Services Task Force, Grossman DC, Curry SJ, Owens DK, Bibbins-Domingo K, Caughey AB, et al. Screening for prostate cancer: US Preventive Services Task Force recom-mendation statement. Journal of the American Medical Associ-ation. 2018; 319: 1901–1913.

[15] Houlihan MD, Köhler TS. Updated AUA guidelines on BPH: What urologists need to know. Urology Times Journal. 2020. Available at: https://www.urologytimes.com/view/updated-aua- guidelines-bph-what-urologists-need-know (Accessed: 3 June 2021).

[16] Tasian GE, Cooperberg MR, Potter MB, Cowan JE, Greene KL, Carroll PR, et al. PSA screening: determinants of primary-care physician practice patterns. Prostate Cancer and Prostatic Dis-eases. 2012; 15: 189–194.

[17] Misra-Hebert AD, Hu B, Klein EA, Stephenson A, Taksler GB, Kattan MW, et al. Prostate cancer screening prac-tices in a large, integrated health system: 2007–2014. BJU International. 2017; 120: 257–264.

[18] Berkowitz Z, Li J, Richards TB, Marcus PM. Patterns of Prostate-Specific Antigen Test Use in the U.S., 2005–2015. American Journal of Preventive Medicine. 2017; 53: 909–913.

[19] Asona L, Tiburcio J, Reich D. Caring through the controversy: Primary care provider practice patterns and attitudes to-wards PSA based prostate cancer screening in a high risk area. In Pro-ceedings of the Annual Meeting of the American Association for Cancer Research. Cancer Res. 2020; 80(16 Suppl): Abstract 5739

[20] Sharma V, Venkataramana A, Comulada WS, Litwin MS, Saigal C. Association of reductions in PSA screening across states with increased metastatic prostate cancer in the United States. Journal of Clinical Oncology. 2021; 39: 228.

[21] U.S. Census Bureau. American Community Survey 1-year esti-mates. Retrieved from Census Reporter Profile page for Jeffer-son Parish, LA. 2019. Available at: https://censusreporter.org/p rofiles/05000US22051-jefferson-parish-la/ (Accessed: 27 July 2021).

[22] U.S. Census Bureau. American Community Survey 1-year es-timates. Retrieved from Census Reporter Profile page for Or-leans Parish, LA. 2019. Available at: https://censusreporter.org /profiles/05000US22071-orleans-parish-la/ (Accessed: 27 July 2021).

[23] U.S. Centers for Medicare & Medicaid Services. Prostate cancer screenings. 2021. Available at: https://www.medicare.gov/cov erage/prostate-cancer-screenings (Accessed: 9 June 2021).

[24] Aetna. Prostate Cancer Screening. Updated 25 November 2020. Available at: http://www.aetna.com/cpb/medical/data/500_599/ 0521.html (Accessed: 9 June 2021).

[25] United Healthcare. Preventive Care Services. 2020. Available at: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/signaturevalue-bip/preventive-care-services-c ommon.pdf (Accessed: 9 June 2021).

[26] BlueCross BlueShield. Medical Policy Manual. 2020. Avail-able at: https://www.bcbst.com/mpmanual/!SSL!/WebHelp/Pro state_Specific_Antigen_PSA.htm (Accessed: 9 June 2021).

[27] Hutchinson R, Singla N, Akhtar A, Haridas J, Bhat D, Roehrborn C, et al. Seniority of primary care physicians is associated with a decrease in PSA ordering habits in the years surrounding the United States Preventative Services Task Force recommendation against PSA screening. Urologic Oncology. 2018; 36: 500.e21–

500. e27.

[28] Collins F. Insurance Status Helps Explain Racial Disparities in Cancer Diagnosis. NIH Director’s Blog. 2020. Available at: https://directorsblog.nih.gov/2020/01/21/insurance-status-h elps-explain-racial-disparities-in-cancer-diagnosis/ (Accessed: 3 June 2021).

[29] Awasthi S, Gerke T, Williams VL, Asamoah F, Fink AK, Balkr-ishnan R, et al. Interrelationship between Health Insurance Sta-tus and Prostate Cancer Grade can have Critical Impact on Prostate Cancer Disease Control: A Retrospective Cohort Study. Cancer Control. 2019; 26: 1073274819837184.

[30] Spencer K. A finger or not? Prostate examinations by non-urologists at a South African academic institution. South Afri-can Medical Journal. 2017; 107: 631–635.

[31] Goldenberg MG, Skeldon SC, Nayan M, Suppiah Y, Chow L, Fryml E, et al. Prostate-specific antigen testing for prostate can-cer screening: a national survey of Canadian primary care physi-cians’ opinions and practices. Canadian Urological As-sociation Journal. 2019; 11: 396–403.

[32] Akerman JP, Allard CB, Tajzler C, Kappor A. Prostate cancer screening among family physicians in Ontario: An update on attitudes and current practice. Canadian Urological Association Journal. 2018; 12: E53–E58.

[33] Tabatabai S, Simforoosh N. Preference for Patient -Urologist Gender Similarity and Its Implications for Urology Depart-ments: A Systematic Narrative Review and Thematic Analysis. Urology Journal. 2020; 17: 568–577.

[34] Wynn J, Johns Putra L. Patient preference for urologist gender. International Journal of Urology. 2021; 28: 170–175.

[35] Amir H, Beri A, Yechiely R, Amir Levy Y, Shimonov M, Groutz A. Do Urology Male Patients Prefer Same-Gender Urologist?American Journal of Men’s Health. 2018; 12: 1379–1383.

[36] Nam CS, Daignault-Newton S, Herrel LA, Kraft KH. The Future is Female: Urology Workforce Projection from 2020 to 2060. Urology. 2021; 150: 30–34.

[37] American Urological Association (AUA). 2019 The State of the Urology Workforce and Practice in the United States. Linthicum, Maryland, U.S.A. 2020. Available at: https://www.auanet.org /documents/research/census/2019%20The%20State%20of%20the%20Urology%20Workforce%20Census%20Book.pdf(Accessed: 27 July 2021).

[38] Hayat Roshanai A, Nordin K, Berglund G. Factors influencing primary care physicians’ decision to order prostate-specific anti-gen (PSA) test for men without prostate cancer. Acta Oncolog-ica. 2013; 52: 1602–1608.

[39] Brosman SA, Kim ED. Prostate-Specific Antigen Testing. 2020. Available at: https://emedicine.medscape.com/article/457394-o verview (Accessed: 27 July 2021).

[40] Kappen S, Jürgens V, Freitag MH, Winter A. Early detection of prostate cancer using prostate-specific antigen testing: an empir-ical evaluation among general practitioners and urologists. Can-cer Management and Research. 2019; 11: 3079–3097.

[41] Broderick JM. PSA screening in prostate cancer: The con-troversy continues. Urology Times. 2020. Available at: https://www.urologytimes.com/view/psa-screening-in-prostat

e- cancer-the-controversy-continues (Accessed: 27 July 2021).

[42] Zavaski ME, Meyer CP, Hanske J, Gupta S, Sun M, Trinh QD. Differences in prostate specific antigen testing among urologists and primary care physicians following the 2011 USPSTF recom-mendations. JAMA Intern Med. 2016; 176: 546–547.

[43] Sunaryo PL, Colaco M, Davis R, Sadeghi-Nejad H. Malpractice Litigation in the Setting of Prostate Cancer Diagnosis. Urology Practice. 2015; 2: 17–21.

[44] Stapleton AMF, Johns RL, Kopsaftis T, Tamblyn DJ, Pinnock CB. Abnormal PSA tests–delays in referral. Australian Family Physician. 2008; 37: 84–88.

[45] National Quality Forum (NQF). National Quality Partners Play-book: Shared Decision Making in Healthcare. National Quality Forum: Washington, DC. 2018.

[46] Centers for Medicare & Medicaid Services (CMS). MIPS Improvement Activities. 2020. Available at: https://www.facs.org/-/media/files/quality-programs/ssr/ssr_mips_2020_ia_with_supporting_documentation.ashx (Accessed: 19 July 2021).

[47] Centers for Medicare & Medicaid Services (CMS). Quality Measures: APP Requirements. 2021. Available at: https://qp

p. cms.gov/mips/app-quality-requirements (Accessed: 19 July 2021).

[48] Centers for Disease Control and Prevention, National Center for Health Statistics. National Health Interview Survey. Data are age-adjusted to the 2000 US standard population using age groups: 55–59, 60–69. 2021. Available at: https://progressre port.cancer.gov/detection/prostate_cancer (Accessed: 9 January 2022).

[49] Office of Disease Prevention and Health Promotion (ODPHP). Healthy People 2020: 2020 Topics & Objectives: Cancer [In-dicator C19: Men ever counseled about advantages and disad-vantages of the PSA test (age-adjusted, percent, 40+ years)]. 2022. Available at: https://www.healthypeople.gov/2020/topics- objectives/topic/Cancer/objectives#4060 (Accessed: 9 January 2022).

[50] Office of Disease Prevention and Health Promotion (ODPHP). Healthy People 2020: Disparities Details by Health In-surance Status for 2018 [Indicator C19: Men ever counseled about ad-vantages and disadvantages of the PSA test (age-adjusted, per-cent, 40+ years)]. 2020. Available at: https://www.healthyp eople.gov/2020/data/disparities/detail/Chart/4060/11/2018 (Ac-cessed: 9 January 2022).

[51] Bleyer A, Spreafico F, Barr R. Prostate cancer in young men: An emerging young adult and older adolescent challenge. Cancer. 2020; 126: 46–57.

[52] Nettey OS, Walker AJ, Keeter MK, Singal A, Nugooru A, Martin IK, et al. Self-reported Black race predicts sig-nificant prostate cancer independent of clinical setting and clinical and socioe-conomic risk factors. Urologic Oncology. 2018; 36: 501.e1– 501. e8.

[53] Vickers AJ, Eastham JA, Scardino PT, Lilja H. The Memorial Sloan Kettering Cancer Center Recommendations for Pros-tate Cancer Screening. Urology. 2016; 91: 12–18.

[54] Tikkinen KAO, Dahm P, Lytvyn L, Heen AF, Vernooij RWM, Siemieniuk RAC, et al. Prostate cancer screening with prostate-specific antigen (PSA) test: a clinical practice guideline. British Medical Journal. 2018; 362: k3581.


Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Directory of Open Access Journals (DOAJ) DOAJ is a unique and extensive index of diverse open access journals from around the world, driven by a growing community, committed to ensuring quality content is freely available online for everyone.

SCImago The SCImago Journal & Country Rank is a publicly available portal that includes the journals and country scientific indicators developed from the information contained in the Scopus® database (Elsevier B.V.)

Publication Forum - JUFO (Federation of Finnish Learned Societies) Publication Forum is a classification of publication channels created by the Finnish scientific community to support the quality assessment of academic research.

Scopus: CiteScore 0.9 (2023) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Norwegian Register for Scientific Journals, Series and Publishers Search for publication channels (journals, series and publishers) in the Norwegian Register for Scientific Journals, Series and Publishers to see if they are considered as scientific. (https://kanalregister.hkdir.no/publiseringskanaler/Forside).

Submission Turnaround Time

Conferences

Top