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October 15, 2013

Primary care physicians (PCPs) vary as much as 10-fold when it comes to prostrate-specific antigen (PSA)

screening. Researchers have not yet been able to explain why the difference between the highest and lowest deciles

of PCPs is so large, although more than a quarter of the variance was associated with the particular PCP a patient

saw.

Elizabeth Jaramillo, MD, from the Sealy Center of Aging, University of Texas Medical Branch, Galveston, and

colleagues published their review of Medicare data in the October 16 issue of JAMA. The study was designed to

determine whether PSA screening rates would vary substantially among PCPs .

The authors identified PCPs who had at least 20 male patients aged 75 years or older who did not have a prior

diagnosis of prostate cancer. To be included in the analysis, PCPs had to have seen their male patient on 3 or more

occasions in 2009. The researchers excluded patients in health maintenance organizations because of incomplete

data on testing and recommendations. Overall, they included 1963 PCPs in the analysis and 61,351 patients.

The authors estimated PCP screening rates for 2010. They divided the PCPs into 10 groups on the basis of their

screening rates.

The authors found that 24.2% of PCPs had PSA screening rates that were significantly higher than the mean rate of

49.8% (95% confidence interval, 48.8% - 50.8%). A high percentage (16.0%) of PCPs had significantly lower rates,

with a mean rate of 6.1% (95% confidence interval, 5.9% - 6.3%).

When they examined the reasons for the variance in a multivariate model, the researchers found that patient

characteristics such as age and comorbidities explained just 3.7% of the difference in screening rates. In contrast,

27% of the variance was explained by the particular PCP a patient saw.

"The high variability among PCPs in ordering PSA screening for older men requires additional study to understand its

causes. It has been suggested that overtesting rates be included as quality measures of PCPs. Medicare data can

be used to generate such measures," the authors write.

At this time, no organization has recommended PSA screening for men older than 75 years. In fact, the American

Academy of Family Physicians recommends against routine PSA screening. They have made their evidence-based

recommendation as part of the American Board of Internal Medicine Foundation Choosing Wisely campaign, released

September 24. The goal of Choosing Wisely is to avoid unnecessary care.

Recent studies have suggested that routine PSA screening does more harm than good, and some investigators have

proposed that 3 PSA tests over a lifetime may be sufficient.

This research was supported by Comparative Effectiveness Research on Cancer in Texas, the Cancer Prevention

Research Institute of Texas, the National Institutes of Health, the Agency for Healthcare Research and Quality, and

the University of Texas Medical Branch Clinical and Translational Science Award. The authors have disclosed no

relevant financial relationships.

JAMA. 2013;310:1622-1624.

Medscape Medical News © 2013 WebMD, LLC

PSA Screening: Wide Variation in PCP Recommendations Lara C. Pullen, PhD

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Cite this article: PSA Screening: Wide Variation in PCP Recommendations. Medscape. Oct 15, 2013.