PSA testing still common in men >75 years

Many physicians continue to administer the PSA test to even their oldest patients despite the fact that no medical organization recommends routine prostate cancer screening in men older than 75 years of age, according to recently published research.

In a research letter published in JAMA (2013; 310:1622-4), researchers from the University of Texas Medical Branch at Galveston reported a high variability in standard PSA-ordering practice among primary care physicians. Some physicians ordered the test for their older male patients regularly, despite more than a decade of recommendations against doing so. The physicians’ tendency to order the test had little to do with measurable patient characteristics.

“Our results suggest that a major reason for the continued high PSA rate is decision-making by the physicians,” said senior author James Goodwin, MD. “That’s why there was so much variation among physicians, after accounting for differences among patients. It is clear that some of the overuse is because of preferences of individual patients, but the conclusion of our results is that much more is coming from their primary care physicians.”

The purpose of the study was to determine the role primary care physicians play in whether a man receives PSA screening. The authors looked at the complete Medicare Part A and Part B data for 1,963 Texas physicians who had at least 20 men age 75 years or older in their panels and who saw a man three or more times in 2009.

Of the 61,351 patient records examined, 41% of men received a PSA screening that year, and 29% received a screening ordered by their primary care physician.

Which primary care physician a man sees explained approximately seven times more of the variance in PSA screening than did the measurable patient characteristics, such as age, ethnicity, and location, according to the authors.

Additional research is needed to understand why some primary care physicians order PSA screenings more often than others. The study suggests that overtesting rates be included as quality measures of primary care physicians. Medicare data can be used to generate such measures.

In May, the AUA recommended shared decision making for men age 55 to 69 years who are considering PSA screening. Other organizations, including the American Cancer Society, the American Academy of Family Physicians, and the American College of Physicians, have called for curtailing routine annual PSA testing.

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