Variation in prostate-specific antigen screening in men aged 80 and older in fee-for-service Medicare

J Am Geriatr Soc. 2010 Apr;58(4):674-80. doi: 10.1111/j.1532-5415.2010.02761.x. Epub 2010 Mar 22.


Objectives: To determine the rate of prostate-specific antigen (PSA) screening in men aged 80 and older in Medicare and to examine geographic variation in screening rates across the U.S.

Design: Retrospective cohort study of variation across hospital referral regions using administrative data.

Setting: National random sample in fee-for-service Medicare.

Participants: Medicare beneficiaries aged 80 and older in 2003.

Measurements: Percentage of men aged 80 and older screened using the PSA test.

Results: The national rate of PSA screening in men aged 80 and older was 17.2%, but there was wide variation across regions (<2-38%). Higher PSA screening in a region was positively associated with greater total costs (correlation coefficient (r)=0.49, P<.001), greater intensive care unit use at the end of life (r=0.46, P<.001), and greater number of unique physicians seen (r=0.36, P<.001). PSA screening was negatively associated with proportion of beneficiaries using a primary care physician as opposed to a medical subspecialist for the predominance of ambulatory care (r=-0.38, P<.001).

Conclusion: PSA screening in men aged 80 and older is common practice, although its frequency is highly variable across the United States. Its association with fragmented physician care and aggressive end-of-life care may reflect less reliance on primary care and consequent difficulty informing patients of the potential harms and low likelihood of benefit of this procedure.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged, 80 and over
  • Analysis of Variance
  • Cost of Illness
  • Fee-for-Service Plans / statistics & numerical data*
  • Health Care Costs / statistics & numerical data
  • Health Care Surveys
  • Humans
  • Life Expectancy
  • Male
  • Mass Screening / adverse effects
  • Mass Screening / methods
  • Mass Screening / statistics & numerical data*
  • Medicare / statistics & numerical data*
  • Patient Selection
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Primary Health Care / statistics & numerical data
  • Prostate-Specific Antigen / blood*
  • Prostatic Neoplasms / blood
  • Prostatic Neoplasms / diagnosis*
  • Retrospective Studies
  • United States


  • Prostate-Specific Antigen