Use of prostate-specific antigen for prostate cancer screening in primary care practice
R. B. Williams, M. Boles and R. E. Johnson
Medical College of Virginia, Virginia Commonwealth University, Richmond, USA.
OBJECTIVE: To examine prostate-specific antigen (PSA) as a screening test
in randomly selected primary care practices. DESIGN: Chart abstractions of
a random selection of 552 men (age, > or = 50 years) and physician and
practice-level surveys. SETTING: Fifty-eight randomly selected,
nonteaching, non-governmental, primary care practices in a 43-county area
in Virginia. MAIN OUTCOME MEASURES: Documented evidence of PSA screening
for asymptomatic male patients and physician self-report on regular (annual
or biannual) use of PSA screening. RESULTS: Of 496 asymptomatic men, 123
(25%) seen in a 1-year period had documentation of PSA screening. Sixty
(50%) of 120 asymptomatic men with documentation of a health maintenance
examination had a PSA screening, whereas only 63 (17%) of 376 men without
health maintenance examination had a PSA screening (chi 2, P < .001),
after adjusting for race, insurance status, and age. Comparison of PSA
screening use before and after the November 1992 publication of the
American Cancer Society guidelines on PSA screening revealed that PSA
screening after the publication date was 26%, compared with 19% before the
data (P = .045), adjusting for health maintenance examination and the
length of time for which the patient was eligible for screening. Logistic
regression on physician self-report of regular vs not regular PSA use found
an odds ratio of 6.12 (95% confidence interval, 1.28 to 29.30) for
influence of the guidelines and 0.96 (95% confidence interval, 0.93 to
0.99) for the proportion receiving Medicaid or uninsured in the practice.
CONCLUSIONS: Despite controversy over PSA as a screening test, PSA
screening has now spread substantially in primary care practice.
