Abstract 2312: Application of PSA screening guidelines in the clinical setting

Background: Louisiana has the 2nd highest incidence rate and the 7th highest mortality rate from prostate cancer in the United States. Overall, the incidence rates are significantly higher in African American men versus Whites. An annual prostate specific antigen (PSA) test is the standard screening for early detection, but in 2012 the U.S. Preventive Services Task Force (USPSTF) recommended against regular PSA screening testing in men of all ages. This was later revised in 2018 to recommend informed decision-making with men between the ages of 55 and 69 years old. For men older than this, it was still recommended to refrain from regular PSA screening. The purpose of this study is to characterize the clinical practices of PSA screening at LSU Healthcare Network (LSUHCN). Methods: Retrospective medical chart review of 316 randomly selected men, 55-69 years old, who were active patients within the LSUHCN clinics between August 1, 2014 and July 31, 2019. Information was extracted from their medical records to report on the total number of PSA screening received in this time frame; specialty and gender of the physician who ordered the testing; race/ethnicity of the patient; and the insurance type for the patient. To protect the privacy of the participants, patient data was de-identified and is reported in aggregate. Results: Majority of the patients were White (49%) and African American (38%) and majority of them (79%) have not had PSA screening in the last 5 years. Of those patients with PSA exams (n=67), 29 received PSA for early detection screening, 8 for follow-up of elevated PSA, 18 for prostate related conditions, and 12 for prostate cancer control. No significant differences were found between the race of patients, number of PSA screenings received, and specialty/gender of providers. However significant differences were found by race and insurance type (p=0.002), with higher percentages of Whites (16%) having private insurance than African Americans (4%). In total 19 providers (7 urologists, 1 oncologist, 4 nurse practitioners, 6 internal medicine, and 1 family medicine) ordered 183 total exams during the period (M=9.6). Although no significant differences were found by specialty of physician ordering the exams and reason to order it, most of exams were ordered by urologists (78%) followed by nurse practitioners (11%) and internal medicine (7%). Conclusion: Within the LSUHCN, the majority of male patients are not being screened for early detection of prostate cancer, which could be indicative of the LSUHCN following the 2012 USPSTF guidelines recommending no PSA screening at all. Although PSA screenings for early detection of prostate cancer should be discussed during wellness/annual checkup visits, most of the PSA exams for screening were ordered by urologists instead of primary care providers (PCPs). Considering that the updated 2018 guidelines recommend shared-decision making between patients and providers, new studies are needed to revise changes in PCP practices regarding PSA screenings in the next years. Citation Format: Elizabeth Yanes, Margarita Echeverri. Application of PSA screening guidelines in the clinical setting [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2312.