1253 AN EXAMINATION OF PSA UTILIZATION AND REFERRAL PATTERNS IN A LARGE, INTEGRATED HEALTH CARE SYSTEM FOLLOWING THE US PREVENTATIVE SERVICES TASK FORCE PSA RECOMMENDATIONS

INTRODUCTION AND OBJECTIVES: The United States Preventive Services Task Force (USPSTF) first recommended against population-based screening of prostate cancer by giving PSA screening a D rating in October 2011. We examined the utilization of PSA within a large multi-specialty hospital system before and after the recommendation. METHODS: MultiCare (MHS) is a large multi-specialty health care system with nearly 600 providers and 5 employed urologists. We counted and reviewed all new PSA consultations, prostate biopsy procedures (new, not as part of an active surveillance protocol), and PSA tests ordered by the entire system between April 1, 2011 and October 31, 2012 in an effort to document the impact of the USPSTF PSA rating. RESULTS: A total of 240 referrals for elevated PSA were seen and 164 prostate biopsies were performed during the study period. In the 6 months following the USPSTF recommendations, a 17% decrease in referrals for elevated PSA and a 16% decrease in the numbers of biopsies performed was documented. At 12 months following the recommendations, a 28% decrease in elevated PSA referrals and a 64% decrease in number of biopsies performed was measured. There was a more modest decline of 5% in the number of PSA tests performed overall at our institution. CONCLUSIONS: The USPSTF ‘D’ rating of PSA made a substantial impact on PSA utilization, both as a screening tool and an indicator for prostate biopsy, within the our integrated health care system. Additional study on a broader scale is necessary to confirm these findings.