||5R01CA134425-05 Interpret this number
||Northern California Institute/Res/Edu
||Prostate-Specific Antigen Practices and Outcomes in the Elderly
Prostate-specific antigen (PSA) screening for the early detection of prostate cancer has been widely
adopted in the U.S. among elderly men, including those with limited life expectancy. Such screening is
grounded in pervasive beliefs that screening is always the safest course of action, despite the uncertain
benefit of PSA screening. Therefore, this proposal makes innovative use of VA and Medicare claims-based
data and electronic health records to determine factors associated with PSA screening and the downstream
consequences following screening in elderly men across a spectrum of advancing age and comorbid illness.
This includes men with favorable 10-year life expectancy for whom several guidelines recommend
screening, and men with limited life expectancy for whom screening is unlikely to be beneficial. Such data
are fundamental for informed PSA screening decisions among the many elderly men who are considering
screening and for the development of quality measures that reward clinicians for avoiding excessive testing.
This application proposes a cohort study of 826,908 men aged 65 years and older who were seen at 104
Veterans Affairs (VA) facilities during 2002 and 2003, without a history of prostate cancer, elevated PSA, or
prostate cancer symptoms. VA data and Medicare claims will be used to measure the performance of PSA
testing during 2003 as well as the health-system, provider, and patient-level determinants of screening and
the downstream consequences following screening. Subsets of men will also be selected to obtain richer
clinical detail from electronic health records about additional determinants and consequences of screening.
The aims of this project are 1) to determine the health-system, provider, and patient factors associated
with PSA screening in elderly men across a spectrum of advancing age and comorbid illness; 2) to quantify
the real world downstream consequences (e.g., PSA testing, prostate biopsies, cancer diagnosis, treatment,
and complications) during the 3 years following PSA screening in elderly men across a spectrum of
advancing age and comorbid illness; and 3) to identify health-system, provider, and patient factors
associated with these downstream consequences. Factors associated with PSA screening and initiating
each step in the cascade of downstream consequences will be identified according to life expectancy to
determine where targeted interventions are needed to discourage excessive testing in elderly men.