Are we ordering too many PSA tests? Prostate cancer diagnosis and PSA screening patterns for a single Veterans Affairs Medical Center

Background. Limits on the frequency of PSA testing and an endpoint for the age of the screened population have not been established. The numbers of pe rformed serum PSA tests, cost evolution, and utilization patterns by variou s subspecialties in one medical center were analyzed to gain insight into t rends in screening for early detection of prostate cancer and gather inform ation about the appropriate use of PSA testing. Method. Computerized record s were reviewed for numbers of PSA tests obtained, prostate biopsies perfor med, and prostate cancer cases diagnosed in the VA NJ-Health Care System fr om 1996 to 1998. In addition, PSA tests performed during two representative weeks in 1996 and 1997 were analyzed to evaluate a smaller cohort of patie nts with regard to age, consequences of the test results in their managemen t, and subspecialties ordering the tests. Results. PSA testing increased st eadily between 1992 and 1998, with the most significant change (152% increa se) between 1997 (9,410 tests) and 1998 (23,684). Prostate cancer diagnoses by biopsy were 164/434 (37.8%) in 1997 and 195/507 (38.5%) in 1998. For th e 14,274 additional PSA tests obtained in 1998, 31 more prostate cancers we re diagnosed. Prostate cancer diagnoses per PSA tests were 164/9,410 (1.8%) in 1997 and 195/23,684 (0.8%) in 1998. Primary care providers ordered 61% of the PSA tests. Conclusions. Most PSA tests at this institution were orde red by general practitioners, and the number of PSA tests ordered for men o ver 75 was high. The dramatic increase between 1997 and 1998 was not accomp anied by a similar rise in the diagnosis of prostate cancer, raising the po ssibility of indiscriminate PSA testing or unnecessary repetition of testin g. Guidelines for prostate cancer screening and continued PSA testing in th e geriatric population may need further clarification.