PCPs Diligent With Following USPSTF Recommendations on PSA Testing

Using data gathered from the National Ambulatory Medical Care Survey, the authors of a JAMA Internal Medicine study identified a significant decrease in PSA testing referrals by primary care physicians compared with urologists.

Declines in prostate-specific antigen (PSA) testing differed among urologist and primary care physician visits in a study that compared testing before and after a 2011 recommendation from the US Preventive Services Task Force against PSA screening for all men, according to an article published online by JAMA Internal Medicine.

The authors gathered data from the National Ambulatory Medical Care Survey to examine continued adoption of PSA testing before (2010) and after (2012) the USPSTF recommendation. The survey, write the authors, collects information on outpatient physician visits, patient demographics, diagnoses, medications, and indications for consulting. The authors included all visits for men (ages 50 to 74 years) who went to urologists or primary care physicians (PCPs) for a preventive care visit. After excluding men with a diagnosis of prostate cancer and other conditions of the prostate, the study sample included 1164 visits (representing 27 million eligible visits) in 2010 and 2012, of which 64 visits (representing 800,000 visits) were provided by urologists and 1100 visits (representing 26.2 million visits) were by PCPs.

Use of PSA testing decreased from 36.5% in 2010 to 16.4% in 2012 among PCP visits (odds ratio [OR], 0.43; 95% CI, 0.23-0.81; P = .009) and from 38.7% in 2010 to 34.5% in 2012 among urologist visits (OR, 0.34; 95% CI, 0.10-1.20; P = .09), the authors discovered.

The authors explain that the difference in decline may either reflect differing perceptions among physicians on the benefit of PSA screening, conflicting guidelines (the American Urological Association recommends joint decision making for men 55 to 69 years), or possibly patient demographics or expectations.

Important study limitations to note include relying on records of outpatient clinic visits and not accounting for PSA testing outside of physician outpatient visits. Also, the authors used the order of a PSA test as a surrogate for an actual test being performed, which may not necessarily be accurate.

“Moving forward, this finding emphasizes the need to continue interdisciplinary dialogue to achieve a broader consensus on prostate cancer screening,” the authors conclude.

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