Allard Christopher, Yip Paul, Blasutig Ivan, Hersey Karen, Fleshner Neil
University of Toronto, Toronto, ON;
Can Urol Assoc J. 2010 Oct;4(5):317-20. doi: 10.5489/cuaj.09165.
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.
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.
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.
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 user-selectable 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.
游离前列腺特异性抗原（PSA）百分比可辅助总PSA进行前列腺癌筛查，但对既往已确诊前列腺癌的患者进行监测并无益处。在加拿大多伦多安大略省的三级癌症中心玛格丽特公主医院，PSA值在4至10 ng/mL范围内时会促使进行游离PSA的反射性检测。我们推测，在三级癌症中心进行反射性游离PSA检测会产生不必要的费用，因为该检测通常是针对既往已确诊前列腺癌的患者进行的。
我们回顾了本机构在10年期间对250名男性随机样本进行的所有反射性游离PSA检测。我们确定了触发反射性游离PSA检测的PSA检测的临床指征，以估计无临床指征的游离PSA检测比例。
我们回顾了250名受试者的1099次反射性游离PSA检测。在这些检测中，562次（51%）是由用于筛查/早期检测的PSA检测触发的，537次（49%）是用于监测的。
在所有反射性游离PSA检测中，49%是不必要的。我们进行了3022次游离PSA检测，每次检测成本为5.84加元；这些检测于2009年在本机构进行，总成本为17648.48加元，其中约49%（8647.76加元）可能代表不必要的年度成本。我们建议进行一项关于用户可选择医嘱集的试验，允许医生根据具体情况选择是否包括反射性游离PSA检测。这一政策可能会提高三级癌症中心PSA检测的成本效益。
