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High Rates of PSA Testing in Older Men

Summary and Comment |
October 29, 2013

High Rates of PSA Testing in Older Men

  1. Thomas L. Schwenk, MD

In Texas, 29% of men older than 75 received physician-ordered prostate-specific antigen testing.

  1. Thomas L. Schwenk, MD

No evidence shows benefit, nor does an official recommendation exist, for prostate-specific antigen (PSA) testing in men older than 75; nonetheless, testing continues to be performed in many older men. In this study, researchers used Texas Medicare data to assess PSA testing in 61,351 older men (age, ≥75) who were seen in 2010 by 1963 primary care physicians; each physician saw at least 20 such patients.

Overall, 29% of patients had PSA screening tests ordered by their physicians; the rate ranged from 50% (among physicians who ordered PSA tests with significantly above-average frequency) to 6% (among physicians who ordered with significantly below-average frequency). PSA test–ordering behavior, as opposed to patient characteristics, explained most of the difference.

Comment

These results confirm the known high and inappropriate rate of PSA testing in older men. However, the good news is that some physicians appear to be responding correctly to the lack of evidence for such testing and to be refraining from its use. The authors suggest that quality measures should focus on overuse of tests like this, as well as underuse.

  • Disclosures for Thomas L. Schwenk, MD at time of publication Editorial boards UpToDate

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