IDENTIFYING BARRIERS TO TIMELY FOLLOW-UP AFTER ELEVATED PSA SCREENING: A RETROSPECTIVE ANALYSIS OF A LARGE HEALTHCARE SYSTEM

Abstract

Introduction

Prostate cancer is the most common solid organ cancer and the second leading cause of cancer-related mortality among American men. Early detection and timely treatment are crucial for effective management. Despite updated guidelines from the United States Preventive Services Task Force in 2018 recommending shared decision-making for PSA screening in men aged 55-69 years, barriers to timely follow-up care persist. This study aims to examine elevated PSA follow-up within our healthcare system and identify barriers to timely diagnosis of prostate cancer.

Methods

We analyzed data from the Mass General Brigham's Enterprise Data Warehouse, focusing on patients with elevated PSA levels from 2018-2021. Timely follow-up was defined as having a urologist appointment, prostate biopsy, or prostate MRI within 6 months of diagnosis. The location of elevated PSA diagnosis was categorized as academic medical centers versus community sites. Univariable and multivariable analyses were conducted to identify factors impacting follow-up.

Results

Our cohort included 28,346 patients, with 50.30% receiving timely follow-up, 15.02% experiencing untimely follow-up, and 34.69% having no follow-up. Multivariable analysis showed that patients diagnosed at academic medical centers were more likely to receive follow-up care (OR=1.39, 95%CI 1.30-1.48). Sensitivity analysis incorporating two major community hospitals into the academic category revealed even higher odds of timely follow-up (OR=1.61, 95%CI 1.51-1.73).

Conclusions

Significant variation exists in follow-up rates between academic medical centers and community sites, underscoring the need for strategies to ensure timely and consistent prostate cancer follow-up care across all facilities. Addressing these disparities can enhance timely care delivery and improve patient outcomes.