THE USE OF PROSTATE-SPECIFIC ANTIGEN FOR PROSTATE-CANCER SCREENING - A MANAGED CARE PERSPECTIVE

A large nonprofit staff model Health Maintenance Organization experien ced increased use of prostate specific antigen (PSA) as a screening te st for prostate cancer beginning in May 1991. A critical evaluation of the evidence in support of PSA screening was done and concluded that the use of PSA to screen for prostate cancer did not meet the criteria for an effective screening program. A guideline stating that PSA was not recommended as a screening test was implemented focusing on a mode l of shared decision making. PSA test ordering decreased significantly when patients were fully informed about the evidence for PSA screenin g. If PSA screening had continued at the peak rate, the cascade of int ervention initiated by screening would have resulted in significant co mplications and approximately $4,800,000 in increased costs.