Lack of follow-up of prostate-specific antigen test results

Public Health Rep. Sep-Oct 2009;124(5):718-25. doi: 10.1177/003335490912400514.

Abstract

Objectives: We obtained population estimates of the prevalence of lack of diagnostic follow-up after an abnormal prostate-specific antigen (PSA) result and assessed the role of sociodemographic, access, and risk perception factors on follow-up of abnormal tests.

Methods: We used data from the 2000 National Health Interview Survey cancer control supplement. For 3,310 men aged 40 or older with a PSA test, 463 men reported an abnormal PSA test. Outcomes were abnormal PSA and lack of diagnostic follow-up in the latter group. Covariates for logistic regression included sociodemographic variables (age, race/ethnicity, and education), access to care (health insurance and usual source), and risk of cancer (family history and perceived risk). Survey analysis procedures accounted for the complex survey design.

Results: Abnormal PSA results were associated with age, family history, and perceived risk of cancer. Approximately 15% of men with abnormal PSA tests reported no follow-up. The estimated number was 423,549 (95% confidence interval [CI] 317,755, 529,343). No follow-up was more likely in Hispanic men (odds ratio [OR] = 2.21, 95% CI 1.04, 4.70) and men without insurance (OR=6.56, 95% CI 2.02, 21.29), but less likely in men with a family history of prostate cancer or higher perceived risk of cancer.

Conclusions: Substantial numbers of men had no follow-up of abnormal PSA tests. Primary care physicians should assess continuity of care following abnormal PSA results. Data about prostate cancer screening and follow-up are needed to support clinical and policy decisions.

MeSH terms

  • Adult
  • Aged
  • Continuity of Patient Care
  • Follow-Up Studies
  • Health Care Surveys
  • Humans
  • Logistic Models
  • Male
  • Mass Screening
  • Middle Aged
  • Patient Acceptance of Health Care*
  • Prostate-Specific Antigen / blood*
  • Prostatic Neoplasms / blood
  • Prostatic Neoplasms / diagnosis*
  • Prostatic Neoplasms / prevention & control
  • Risk Assessment
  • United States

Substances

  • Prostate-Specific Antigen