Hoffman R M, Blume P, Gilliland F
Department of Medicine, Albuquerque Veterans Affairs Medical Center, University of New Mexico, 87108, USA.
J Gen Intern Med. 1998 Feb;13(2):106-10. doi: 10.1046/j.1525-1497.1998.00026.x.
To characterize prostate-specific antigen (PSA) testing practices in a hospital-based primary care clinic, and to determine the outcomes of PSA testing, including urology referrals, biopsies, cancers detected, and cancer treatments.
Retrospective cohort study. Data were obtained from computerized Department of Veterans Affairs (VA) files and the statewide New Mexico Surveillance, Epidemiology, and End Results (SEER) tumor registry.
Primary care clinics in a university-affiliated VA Medical Center.
Subjects were 1,448 men without cancer undergoing PSA testing in 1993 with follow-up through 1994.
Twenty-one percent of clinic enrollees at least 40 years of age were tested with PSA, including 58 who were 75 years of age or older. By the end of 1994, 40.0% (95% confidence interval [CI] 37.2%, 42.8%) were retested; 25.6% (95% CI 21.7%, 29.5%) of initial retesting occurred within 6 months. Overall, 20.7% (95% CI 18.9%, 22.5%) of PSA tests in the cohort were for men aged 75 years or older and were repeated within 6 months. Among the 193 subjects with PSA values > or = 4.0 ng/mL, 86.0% (95% CI 81.1%, 90.9%) were followed-up in urology clinic, and 46.1% (95% CI 39.1%, 53.1%) underwent biopsy. Only 11 of 51 men aged 75 years or older who were referred to urologists for an elevated PSA underwent biopsy. Forty cancers were diagnosed-a detection rate of 2.8% (95% CI 2.0%, 3.6%). Of these, 28 were organ-confined, 7 had regional invasion, and 3 had distant metastases.
Primary care providers frequently ordered PSA tests, but a substantial proportion of testing occurred outside recommended age ranges and screening intervals. Older patients with elevated PSA values often did not complete diagnostic workups. Better adherence to screening guidelines may limit the number of both PSA tests and urology referrals.
描述一家医院基层医疗诊所中前列腺特异性抗原（PSA）检测的实施情况，并确定PSA检测的结果，包括泌尿外科转诊、活检、检测出的癌症以及癌症治疗情况。
回顾性队列研究。数据来自退伍军人事务部（VA）的计算机化档案以及新墨西哥州全州范围的监测、流行病学和最终结果（SEER）肿瘤登记处。
一所大学附属VA医疗中心的基层医疗诊所。
研究对象为1993年接受PSA检测且随访至1994年的1448名无癌症男性。
年龄至少40岁的诊所登记患者中有21%接受了PSA检测，其中包括58名75岁及以上的患者。到1994年底，40.0%（95%置信区间[CI] 37.2%，42.8%）的患者进行了重新检测；25.6%（95% CI 21.7%，29.5%）的首次重新检测在6个月内进行。总体而言，队列中20.7%（95% CI 18.9%，22.5%）的PSA检测是针对75岁及以上男性且在6个月内重复进行。在193名PSA值≥4.0 ng/mL的受试者中，86.0%（95% CI 81.1%，90.9%）在泌尿外科诊所接受了随访，46.1%（95% CI 39.1%，53.1%）接受了活检。在因PSA升高而被转诊至泌尿外科的51名75岁及以上男性中，只有11人接受了活检。共诊断出40例癌症，检测率为2.8%（95% CI 2.0%，3.6%）。其中，28例为器官局限性癌症，7例有区域侵犯，3例有远处转移。
基层医疗服务提供者经常开具PSA检测医嘱，但很大一部分检测发生在推荐年龄范围和筛查间隔之外。PSA值升高的老年患者往往未完成诊断检查。更好地遵循筛查指南可能会限制PSA检测和泌尿外科转诊的数量。
