Male urologists more likely to order inappropriate PSA test

Practitioners who specialize in urology, who are male, who seldom order PSA tests, and who are affiliated with specific hospitals are more likely than are other medical practitioners to inappropriately order a PSA test for asymptomatic patients over age 75 years or under age 40, according to a study from the Massachusetts Veterans Epidemiology Research and Information Center.

Data on PSA test use between 1997 and 2004 were accrued from the databases at seven New England Veterans Health Administration hospitals. Using prostate needle biopsy CPT code 55700 and ICD-9 code 60.11, researchers isolated 4,823 practitioners who ordered the test for 181,139 men.

Of more than 232,000 PSA tests ordered, 37,384 (16.1%) were deemed inappropriate: 35,612 of the men (15.3%) were over age 75; 1,871 (.8%) were under age 40. Among health care practitioners who ordered the test, 51.3% were men, 79.4% were physicians, 53.4% were physicians in training, and 8.2% were urologists. Compared with attending physicians, physician extenders were significantly less likely to test inappropriately (p<.05).

Univariate analysis of provider characteristics found urologists, male health care providers, and health care providers who ordered PSA tests infrequently (less than 1 per week) were significantly more likely to inappropriately order PSA tests. Multivariate analysis determined that inappropriate testing among the seven hospitals and with respect to ordering frequency remained statistically significant (p<.03).

Further, the number of inappropriate PSA tests increased significantly (p<.001) with the age of male health providers over age 40, but decreased with the age of female health providers (p=.048).

“The cause of the sex and age differences is not clear,” lead author B. Price Kerfoot, MD, EdM, wrote. “It is possible that, as they age, male health care providers increasingly empathize with their older male patients over prostate cancer concerns. Their ‘prostatempathy’ may then lead to more aggressive screening in these older male patients.”

The study was published in Archives of Internal Medicine (2007; 167:1367-72).