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Health Services Research & Development

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2009 HSR&D National Meeting Abstract

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National Meeting 2009

1081 — Follow-Up for Veterans after an Elevated Prostate Specific Antigen (PSA)

Zeliadt SB (Health Services Research & Development Center of Excellence, VA Puget Sound Health Care System, Seattle), Etzioni RD (Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle), Lin DW (VA Puget Sound Health Care System, Seattle)

Objectives:
To examine follow-up care for veterans with elevated levels of Prostate Specific Antigen (PSA).

Methods:
We identified veterans with an elevated PSA (> 4ng/ml) between 1997 and 2006. Inclusion criteria included < age 85, PSA performed in primary care or urology clinics in VA Puget Sound, patient continued to be part of a primary care provider panel and was alive at 12 months following the abnormal test date, no prior diagnosis of prostate cancer, and no evidence of a prior elevated PSA in available VISN20 databases. Follow-up care was evaluated to determine whether subjects received additional PSA tests and/or a biopsy within 12 and 24 months after their elevated PSA test. Next steps include identifying reasons for lack of follow up, determining whether delaying biopsy is appropriate, and assessing the extent to which veterans receive care outside VHA.

Results:
We identified 1,462 veterans with an abnormal PSA test meeting the eligibility criteria. Within 12 months of the elevated test, 399 (27%) veterans underwent a biopsy, 220 (15%) had received at least one subsequent PSA test with a normal value ( < 4 ng/ml), 301 (21%) had a subsequent PSA test with the value remaining elevated without a biopsy, and 27 (2%) had been diagnosed with prostate cancer without a record of a biopsy performed in VA Puget Sound. Overall, 515 (35%) appear to not have received follow-up related to their elevated test within 1 year, and 285 (19%) did not have follow-up within 2 years. Follow-up was more complete for younger men and those with higher PSA levels. Veterans with lower comorbidity scores were less likely to receive a biopsy. A total of 183 (13%) subjects were diagnosed with prostate cancer within 12 months of an abnormal PSA; an additional 142 (10%) men had been diagnosed through the end of the study.

Implications:
Biopsy frequency following an abnormal PSA in VA Puget Sound appears to be about 15% lower compared to community estimates. Identifying reasons for delays in follow up and variation in provider behavior are essential to providing optimal care to veterans.

Impacts:
Delays in receipt of biopsy in VA Puget Sound following an elevated PSA test underscores the importance of identifying the optimal use of PSA and appropriate follow up care.


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