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What Happens After an Elevated PSA Test: The Experience of 13,591 Veterans

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Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Background

The occurrence and timing of prostate biopsy following an elevated prostate-specific antigen (PSA) test varied considerably in randomized screening trials.

Objective

Examine practice patterns in routine clinical care in response to an elevated PSA test (≥4 ng/μl) and determine whether time to biopsy was associated with cancer stage at diagnosis.

Design

Retrospective cohort study.

Participants

All veterans (n = 13,591) in the Pacific Northwest VA Network with a PSA ≥4 ng/μl between 1998 and 2006 and no previous elevated PSA tests or prostate biopsy.

Main Measures

We assessed follow-up care including additional PSA testing, urology consults, and biopsies. We compared stage at diagnosis for men who were biopsied within 24 months vs. those men biopsied and diagnosed >24 months after the elevated PSA test.

Key Results

Two-thirds of patients received follow-up evaluation within 24 months of the elevated PSA test: 32.8% of men underwent a biopsy, 15.5% attended a urology visit but were not biopsied, and 18.8% had a subsequent normal PSA test. Younger age, higher PSA levels, more prior PSA tests, no co-payment requirements, existing urologic conditions, low body mass index, and low comorbidity scores were associated with more complete follow-up. Among men who underwent radical prostatectomy, a delayed diagnosis was not significantly associated with having a pathologically advanced-stage cancer (T3/T4), although we found an increased likelihood of presenting with stage T2C relative to stage T2A or T2B cancer.

Conclusions

Follow-up after an elevated PSA test is highly variable with more than a third of men receiving care that could be considered incomplete. A delayed diagnosis was not associated with poorer prognosis.

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Acknowledgements

This work was supported by the VA. The VA Office of Research and Development Health Services R&D, Department of Veterans Affairs, funded this study through a Short-term Health Services Project grant: SHP-08-165. The authors are grateful to Adam Batten for data processing, and to Bruce Wynar and Carol Simons for chart review and data abstraction. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. VA Health Services Research & Development Service, Department of Veterans Affairs Medical Center, Seattle, WA, USA

    Steven B. Zeliadt PhD, MPH

  2. Health Services Department, University of Washington, Seattle, WA, USA

    Steven B. Zeliadt PhD, MPH

  3. Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Steven B. Zeliadt PhD, MPH, Ruth Etzioni PhD & Daniel W. Lin MD

  4. Medicine Service, Department of Veterans Affairs Medical Center, Albuquerque, NM; Department of Medicine, University of New Mexico, Albuquerque, NM, USA

    Richard M. Hoffman MD, MPH

  5. Department of Urology, University of Washington, Seattle, WA, USA

    Van Anh T. Ginger MD, PhD & Daniel W. Lin MD

  6. Division of Urology, Department of Veterans Affairs Medical Center, Seattle, WA, USA

    Daniel W. Lin MD

Authors
  1. Steven B. Zeliadt PhD, MPH
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  2. Richard M. Hoffman MD, MPH
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  3. Ruth Etzioni PhD
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  4. Van Anh T. Ginger MD, PhD
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  5. Daniel W. Lin MD
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Corresponding author

Correspondence to Steven B. Zeliadt PhD, MPH.

Additional information

This work was supported by the VA. The VA Office of Research and Development Health Services R&D, Department of Veterans Affairs, Short-term Health Services Project, SHP-08-165, funded this study. Portions of the data presented here were presented at the VA Health Services R&D National Meeting in February 2009 and at the Annual Meeting of the American Urological Association in April 2009.

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Zeliadt, S.B., Hoffman, R.M., Etzioni, R. et al. What Happens After an Elevated PSA Test: The Experience of 13,591 Veterans. J GEN INTERN MED 25, 1205–1210 (2010). https://doi.org/10.1007/s11606-010-1468-9

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  • DOI: https://doi.org/10.1007/s11606-010-1468-9

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