Five-Year Downstream Outcomes Following Prostate-Specific Antigen Screening in Older Men

Walter, Louise C.; Fung, Kathy Z.; Kirby, Katharine A.; Shi, Ying; Espaldon, Roxanne; O’Brien, Sarah J.; Freedland, Stephen J.; Powell, Adam A.; Hoffman, Richard M.

doi:10.1001/jamainternmed.2013.323

Cited by 26 publications

(27 citation statements)

References 47 publications

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“…While these rates are likely greater than those in current practice, if we apply them to our population, we estimate that use of the CCDS tool in GLA would prevent up to 103 biopsies and the possible overtreatment of 54 men each year. 9 These estimates are relatively small, but easy to achieve. Moreover, the relative ease of scaling this targeted and simple intervention across the VHA would be expected to multiply these favorable effects.…”

Section: Discussionmentioning

confidence: 99%

“…Longitudinal follow-up of elderly men screened in 2003 at the VHA confirmed that many suffered significant burdens from treatments for which benefits conferred were debatable. 9 In 2012, VHA leadership asked local facilities to address inappropriate overuse of preventive care and identified PSA screening in men aged 75 and older as a potential area for improvement. 10 In response, we created a clinical computerized decision support (CCDS) tool to remind providers of current recommendations against PSA-based prostate cancer screening for men in this age group.…”

Section: Introductionmentioning

confidence: 99%

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Reducing PSA-Based Prostate Cancer Screening in Men Aged 75 Years and Older with the Use of Highly Specific Computerized Clinical Decision Support

et al. 2015

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INTRODUCTION:In 2012, the Veterans Health Administration (VHA) implemented guidelines seeking to reduce PSA-based screening for prostate cancer in men aged 75 years and older. OBJECTIVES: To reduce the use of inappropriate PSAbased prostate cancer screening among men aged 75 and over. SETTING: The Veterans Affairs Greater Los Angeles Healthcare System (VA GLA) PROGRAM DESCRIPTION: We developed a highly specific computerized clinical decision support (CCDS) alert to remind providers, at the moment of PSA screening order entry, of the current guidelines and institutional policy. We implemented the tool in a prospective interrupted time series study design over 15 months, and compared the trends in monthly PSA screening rate at baseline to the CCDS on and off periods of the intervention. RESULTS: A total of 30,150 men were at risk, or eligible, for screening, and 2,001 men were screened. The mean monthly screening rate during the 15-month baseline period was 8.3 %, and during the 15-month intervention period, was 4.6 %. The screening rate declined by 38 % during the baseline period and by 40 % and 30 %, respectively, during the two periods when the CCDS tool was turned on. The screening rate ratios for the baseline and two periods when the CCDS tool was on were 0.97, 0.78, and 0.90, respectively, with a significant difference between baseline and the first CCDS-on period (p<0.0001), and a trend toward a difference between baseline and the second CCDS-on period (p=0.056). CONCLUSION: Implementation of a highly specific CCDS tool alone significantly reduced inappropriate PSA screening in men aged 75 years and older in a reproducible fashion. With this simple intervention, evidence-based guidelines were brought to bear at the point of care, precisely for the patients and providers for whom they were most helpful, resulting in more appropriate use of medical resources.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reducing PSA-Based Prostate Cancer Screening in Men Aged 75 Years and Older with the Use of Highly Specific Computerized Clinical Decision Support

et al. 2015

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“…15,16 Age on the date of index PSA screening was categorized into five groups: 65 to 69 years, 70 to 74 years, 75 to 79 years, 80 to 84 years, and 85 years and older. Race/Ethnicity was determined primarily from Medicare administrative data, and VA race data was used to fill in missing data (<1%).…”

Section: Methodsmentioning

confidence: 99%

“…However, we conducted chart reviews which showed most PSA tests in our cohort were screening tests. 16 Second, statin use in our study was based on prescription data, rather than actual compliance, which may overestimate statin use among patients. Third, our cohort consists of men who received care in the VA healthcare system, so the generalizability to non-veterans is uncertain.…”

Section: Commentmentioning

confidence: 96%

Statin Medications Are Associated With a Lower Probability of Having an Abnormal Screening Prostate-specific Antigen Result

Shi

Fung

Freedland

et al. 2014

Urology

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Objective To investigate how statin use is associated with the probability of having an abnormal screening prostate-specific antigen (PSA) result according to common PSA thresholds for biopsy (>2.5, >4.0, and >6.5 ng/mL). Methods We conducted a cross-sectional study of 323,426 men aged 65+ who had a screening PSA test in 2003 at a VA facility. The primary predictor was the use of statin medications at the time of index screening PSA test. The main outcome was the screening PSA value. Poisson regressions were performed to calculate adjusted relative risks for having an abnormal screening PSA result according to statin usage. Results Percentages of men with PSA results exceeding commonly used thresholds >2.5, >4.0, and >6.5 ng/mL were 21.0%, 7.6%, and 1.6% respectively. These percentages decreased with statin use, increasing statin dose, duration of statin use, and potency of statin. For example, after adjusting for age, the percentage of men having a PSA exceeding 4.0 ng/mL ranged from 8.2% in non-statin users to 6.2% in men prescribed >40mg simvastatin dose. Adjusted relative risks of having a PSA >4.0 ng/mL were 0.89 (95% CI=0.86–0.93), 0.87 (95% CI=0.84–0.91), and 0.83 (95% CI=0.80–0.87) respectively for men on simvastatin dose of 5–20mg, >20–40mg, and >40mg versus non-statin users. Conclusion Statin use is associated with a reduction in the probability an older man will have an abnormal screening PSA result, regardless of PSA threshold. This reduction is more pronounced with higher statin dose, longer statin duration, and higher statin potency.

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“…Walter et al 3 followed 25 208 male veterans 65 years or older who had a PSA level of greater than 4 ng/mL (nanograms per milliliter and micrograms per liter are interchangeable units). Effort was made to ensure that these levels were all results from screening PSA tests.…”

Section: Cascade Of Harmmentioning

confidence: 99%

Can We Stop Ordering Prostate-Specific Antigen Screening Tests?

Katz¹

2013

JAMA Intern Med

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Five-Year Downstream Outcomes Following Prostate-Specific Antigen Screening in Older Men

Cited by 26 publications

References 47 publications

Reducing PSA-Based Prostate Cancer Screening in Men Aged 75 Years and Older with the Use of Highly Specific Computerized Clinical Decision Support

Reducing PSA-Based Prostate Cancer Screening in Men Aged 75 Years and Older with the Use of Highly Specific Computerized Clinical Decision Support

Statin Medications Are Associated With a Lower Probability of Having an Abnormal Screening Prostate-specific Antigen Result

Can We Stop Ordering Prostate-Specific Antigen Screening Tests?

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