Seniority of primary care physicians is associated with a decrease in PSA ordering habits in the years surrounding the United States Preventative Services Task Force recommendation against PSA screening.

INTRODUCTION: The United States Preventative Services Task Force recommendation against prostate-specific antigen (PSA) screening came in 2012, a time when many new primary care providers (PCPs) had been trained in the PSA screening era. We examined the differential effect of the recommendation on PCPs' PSA screening by physician seniority and evaluated the impact of their individual stated opinions on their screening practices. METHODS: We reviewed 54,684 PCP-directed PSA orders within a tertiary care academic institution from January 2010 to July 2015. Relative proportions of PSA orders per overall unique male ambulatory clinic volume were assessed for the periods of January 1, 2010 to December 31, 2011 (first period) and January 1, 2013 to July 31, 2015 (second period). A survey was subsequently sent to providers in the cohort assessing their attitudes toward the United States Preventative Services Task Force recommendation and responses were compared to physician seniority and actual PSA ordering habits. RESULTS: Of 88 total PCPs assessed, 22 met criteria for inclusion. Overall unique male nononcology care patients were 88,558 for the first period and 140,173 for the second period. Overall proportion of unique male patients screened did not change and proportion of overall unique male patients screened vs. time since residency demonstrated a significant negative trend (R2 = 0.308, P = 0.007, slope of trend line -0.000005). A subsequent survey revealed no correlation of any aspect of the questionnaire with actual real-world screening practice but did note a paradoxical positive association between physician seniority and stated PSA use. CONCLUSION: From January 2010 to July 2015 PSA screening did not change greatly for providers in continuous practice throughout the period. Time since residency completion was significantly associated with screening proportionally fewer men. Provider opinion did not appear to have a strong influence on actual physician practice. These findings further inform future efforts to alter PSA screening.

Testing and referral patterns in the years surrounding the US Preventive Services Task Force recommendation against prostate-specific antigen screening.

BACKGROUND: Since the US Preventive Services Task Force (USPSTF) recommended against prostate-specific antigen (PSA) screening, there have been conflicting reports regarding the impact on the behavior of providers. This study analyzed real-world data on PSA ordering and referral practices in the years surrounding the recommendation. METHODS: A whole-institution sample of entered PSA orders and urology referrals was obtained from the electronic medical record. The study was performed at a tertiary referral center with a catchment in the southern United States. PSA examinations were defined as screening when they were ordered by providers with appointments in internal medicine, family medicine, or general internal medicine. Linear and quadratic regression analyses were performed, and joinpoint regression was used to assess for trend inflection points. RESULTS: Between January 2010 and July 2015, there were 275,784 unique ambulatory visits for men. There were 63,722 raw PSA orders, and 54,684 were evaluable. Primary care providers ordered 17,315 PSA tests and 858 urology referrals. The number of PSA tests per ambulatory visit, the number of referrals per ambulatory visit, the age at the time of the urology referral, and the proportion of PSA tests performed outside the recommended age range did not significantly change. The PSA value at the time of referral increased significantly (P = .022). Joinpoint analysis revealed no joinpoints in the analysis of total PSA orders, screening PSA tests, or examinations per 100 visits. CONCLUSIONS: In the years surrounding the USPSTF recommendation, PSA behavior did not change significantly. Patients were referred at progressively higher average PSA levels. The implications for prostate cancer outcomes from these trends warrant further research into provider variables associated with actual PSA utilization. Cancer 2016;122:3785-3793. © 2016 American Cancer Society.