Does the reflexive measurement of free PSA have a role in a tertiary cancer centre?

Abstract

Purpose: The percent free prostate-specific antigen (PSA) may complement total PSA for prostate cancer screening, but is of no benefit for monitoring patients with previous prostate cancer diagnoses. At the Princess Margaret Hospital, a tertiary cancer centre in Toronto, Ontario, Canada, PSA values in the range 4 to 10 ng/mL prompt reflexive measurements of free PSA. We hypothesize that reflexive free PSA testing at tertiary cancer centres generates unnecessary costs as the test is often conducted on patients with previous diagnoses of prostate cancer. Materials and Methods:We reviewed all reflexive free PSA measurements conducted on a random sample of 250 men in a 10-year period at our institution. We determined the clinical indications for the PSA tests which triggered reflexive free PSA measurements to estimate the proportion of free PSA tests that are not clinically indicated. Results:We reviewed the 1099 reflexive free PSA measurements for the 250 subjects. Of these tests, 562 (51%) were triggered by PSA tests ordered for screening/early detection, and 537 (49%) for monitoring. Conclusions: Of all reflexive free PSA tests, 49% were unnecessary. We conducted 3022 free PSA tests, at a cost of $5.84 per test (Can$); the tests were performed in 2009 at this institution for a total cost of $17 648.48, about 49% of which ($8647.76) likely represents unnecessary annual costs. We suggest a trial of userselectable order sets allowing physicians to choose whether to include reflexive free PSA measurements on a case-by-case basis. This policy might improve the cost-effectiveness of the PSA test at tertiary cancer centres.Can Urol Assoc J 2010;4(5):317-320 RésuméObjectif : Le pourcentage d'antigène prostatique spécifique (APS) libre peut compléter la mesure de l'APS total dans le dépistage du cancer de la prostate, mais il n'est d'aucune utilité pour la surveillance de patients ayant déjà reçu un diagnostic de cancer de la prostate. À l'hôpital Princess Margaret, un centre de soins oncologiques tertiaires de Toronto, en Ontario (Canada), un taux d'APS se situant entre 4 et 10 ng/mL entraîne systématiquement une évaluation des taux d'APS libre. Nous avançons l'hypothèse que la mesure de l'APS libre dans les centres de soins oncologiques tertiaires entraîne des dépenses inutiles car ce test est souvent mené chez des patients ayant déjà reçu un diagnostic de cancer de la prostate.

Can post‐treatment free PSA ratio be used to predict adverse outcomes in recurrent prostate cancer?

“…The FPSAR was not measured in a systematic or standard manner in all patients at the same time point. Our data relied on tests performed either reflexively [22] or in an incidental manner in patients with BCR after radical therapies, with no standardisation on the time the test was performed. However, to counteract this limitation and validate our findings, we analysed the third cohort with prospectively collected samples, where all FPSAR tests were performed at the same time point (e.g.…”

“…The FPSAR was measured incidentally or reflexively (e.g. PSA in the range of 4–10 ng/mL, as per Institutional policy [22]). If multiple FPSAR tests were performed, only the first FPSAR test was analysed.…”