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Cited by 22Prostate Cancer Diagnosis and TreatmentGlobal Cancer Incidence and ScreeningMale Reproductive Health Studies

Prevalence of delayed clinician response to elevated prostate-specific antigen values

Nepple, Kenneth G., Joudi, Fadi N., Hillis, Stephen L., Wahls, Terry L.·2008·Mayo Clinic Proceedings
DOI 10.4065/83.4.439
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Abstract

Objective To assess the frequency of delayed response to an abnormal prostate-specific antigen (PSA) value.Patients and methods Retrospective review of prostate cancer cases diagnosed between January 1, 2000, and December 31, 2005, in a rural Department of Veterans Affairs health care system serving 44,000 veterans across 2 states. Clinician response was defined as a reference to the elevated PSA result in clinical notes, orders for further evaluation, treatment of presumed prostatitis, or a urology visit or referral. Delay was measured as days between an abnormal PSA result and clinician response.Results We identified 327 men who met inclusion criteria with an abnormal PSA value before prostate cancer diagnosis. At first PSA elevation, median age was 64 years; 94% were younger than 75 years. Of the 327 men, 253 (77.4%) had a timely (< or =30 days) response to an abnormal PSA value; 23 (7.0%) had between 31 and 180 days; 24 (7.3%), between 181 and 360 days; and 27 (8.3%), more than 360 days between an abnormal PSA measurement and clinician response. The delayed group had nearly an additional year's (309 days) lapse before completed urologic consultation and prostate gland biopsy (313 days) as compared with the timely group. The presence of urologic symptoms, abnormal results from rectal examination, higher PSA values, and higher PSA velocity (P<.05) were associated with timely clinician response to an abnormal PSA measurement.Conclusion In a cohort of men with prostate cancer and an antecedent abnormal PSA value, 15.6% had more than 180 days between an abnormal PSA measurement and clinician response. These findings add to the growing literature demonstrating that missed results occur more frequently than is generally appreciated. Improved systems for clinical data management are needed.

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Authors
Nepple, K. G., Joudi, F. N., Hillis, S. L., & Wahls, T. L.
Affiliations
  • University of Iowa (US)
  • Iowa City VA Health Care System (US)
Corresponding author
Wahls, Terry L.
ORCID
Venue
Mayo Clinic Proceedings
Publisher
Elsevier BV
Published
2008-04
Volume
83
Issue
4
Pages
439-445
ISSN
0025-6196 (ISSN-L)
DOI
10.4065/83.4.439
OpenAlex
W2082479806
Cited by
22
References
54
Citations by year
2022: 1 · 2018: 1 · 2015: 2 · 2013: 6
FWCI
3.68
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Mayo Clinic Proceedings (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Prostate Cancer Diagnosis and Treatment
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
  • Health Sciences › Health Professions › General Health Professions › Male Reproductive Health Studies
Keywords
prostate-specific antigen, prostate cancer, PSA screening, prostate biopsy, urologic consultation, missed diagnosis, veterans, PSA velocity, rectal examination, urological symptoms
MeSH terms
Adult, Aged, Aged, 80 and over, Clinical Competence, Diagnostic Errors, Follow-Up Studies, Humans, Male, Middle Aged, Predictive Value of Tests, Prognosis, Prostatic Neoplasms, Retrospective Studies, Rural Population, Severity of Illness Index, Time Factors, United States, Prevalence, Prostate-Specific Antigen

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