PSA Testing Patterns Vary By Medical Specialty

By Lori Solomon, Editor, Diagnostic Testing & Emerging Technologies

Prostate specific antigen (PSA) testing varies significantly by physician specialty, according to a research letter published online Feb. 8 in JAMA Internal Medicine. Since recommendations against universal testing in men, PSA testing has declined overall. New data shows it is performed more frequently, however, for patients receiving preventive health services through a urologist compared to testing ordered through primary care physicians.

“The vast majority of PSA testing is still performed by primary care physicians, but there seems to be a continued perception, more firmly held by urologists than by primary care physicians, that the screening is beneficial,” writes co-author David Aaronson, M.D., from Permanente Medical Group in Oakland, Calif., in an accompanying editorial.

Prior studies have shown that as a result of the U.S. Preventive Services Task Force (USPSTF) October 2011 recommendation against PSA screening for all men there have been declines in both rates of PSA testing among men aged 50 to 74 years and prostate cancer incidence.

The researchers in the JAMA Internal Medicine study used the National Ambulatory Medical Care Survey to evaluate the use of PSA testing in 2010 (Dec. 28, 2009 to Dec. 26, 2010) and 2012 (Dec. 28, 2011 to Dec. 26, 2012)—before and after the USPSTF recommendation. Testing patterns were assessed for men receiving a preventive care visit by medical specialty—urologist or primary care provider (general and family practice and internal medicine). The authors note that the analysis reflects orders for PSA testing, not actual testing performed.

The researchers found that the use of PSA testing decreased from 36.5 percent to 16.4 percent among primary care provider visits, whereas it decreased from 38.7 percent to 34.5 percent among urologist visits. While the declines in testing were significant in both specialties, the difference between physician-specific testing practices was also statistically significant.

“Our findings suggest a differential effect of the 2012 USPSTF recommendations on PSA testing among primary care physicians versus urologists,” write the authors led by Michael Zavaski, M.D., from Brigham and Women’s Hospital in Boston, Mass. “Such findings likely reflect opposing perceptions among physicians on the benefit of PSA screening, conflicting guidelines (e.g., the American Urological Association recommends joint decision making for men aged 55 to 69 years), and perhaps differences in patient demographics or expectations.”