Oncology - Prostate
Introduction & Objective :
Recommendations for prostate cancer screening with PSA remain controversial due to the ongoing debate regarding over-detection and over-treatment. As the life expectancy of spinal cord injured men has improved to near that of uninjured men, the debate has grown to include this unique patient population. In this study, we sought to evaluate the national PSA testing rates before and after spinal cord injury among men in the Veterans Health Administration system.
Utilizing the VA Informatics and Computing Infrastructure (VINCI) and Corporate Data Warehouse (CDW), we extracted PSA testing data for individuals with ICD 9/10 codes designating spinal cord injury. This data was further analyzed by annual rate of PSA testing stratified according to race and AUA guideline age groupings.
A total of 41,344 patients from 129 VA Medical Centers were identified in the VINCI database with a diagnosis of spinal cord injury, and data was collected from 1999 to 2017. These men cumulatively underwent 419,140 PSA tests during the given timeframe. Following diagnosis of SCI, the rate of annual PSA testing increased 161% in the under 40 group (0.23 vs 0.60 PSAs/year), increased 54% in the 40-54 group (0.61 vs 0.94), and 27% in the 55-70 group (0.90 vs 1.14), but decreased 3% following SCI diagnosis in the 70 and above group (1.03 vs 1.00). African-American men had a significantly smaller increase in PSA testing rates following SCI diagnosis than the general population, despite increased risk of disease.
The rate of PSA testing in veterans increased significantly following diagnosis of spinal cord injury in all patients injured before age 70. The increase in testing was greater for the non-African-American population. Furthermore, there appears to be over-screening across all SCI populations, particularly in the under-40 and over-70 cohorts. High rates of PSA testing in veterans with spinal cord injury likely relates in part to structured annual evaluations performed in the VHA for this population, in addition to utilization of PSA in benign diagnostic testing.