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  • (±)-Baclofen br Materials and methods br Theory Calcula

    2019-08-16


    Materials and methods
    Theory/Calculation Across the literature, low-value testing measurement is based on population-based analyses that focus on testing in elderly or unhealthy populations. Analysis among Medicare data demonstrates substantial low-value PSA testing in older men [18]. In surveys conducted by the US Census Bureau, an estimated 1.5 million men over 80 years old receive a screening PSA test each year [19]. Much less information is available regarding low-value testing in younger populations (US Census Bureau data suggest 9.4–16.6% of 40–49 year olds receive screening tests each year) [19], and little to no information is available regarding the interval between screening tests. Appreciating how prostate cancer risk factors (family history and African American race), age, and comorbidities/life expectancy interplay in screening decisions and characterizing which men are actually receiving screening is key to understanding the steps necessary for health care systems to improve the value of PSA testing.
    Results Over the study period, 21,145 PSA tests were performed on 12,303 individuals without a diagnosis of prostate cancer. The majority of tests (57.0%) were completed in the reference age group of 55–69 years (Fig. 1). Family history of prostate cancer was noted in the medical record at the (±)-Baclofen time of first PSA test during the study (±)-Baclofen in 10.5% of men. The breakdown of self-reported race for cohort was 83.0% “White or Caucasian”, 2.6% “Asian”, 1.6% “Black or African American”, 0.9% “Native Hawaiian and Other Pacific Islander”, 0.5% “American Indian and Alaska Native” and 11.4% unknown race, other race or multiple race. “Hispanic/Latino” ethnicity was reported in 9.3%. Depending upon the guideline, the rate of low-value testing ranged from 23.4% for NCCN to 56.8% for AUA (Table 1).
    Discussion Among providers performing PSA testing in a large academic health system, substantial testing appears to fall outside guideline recommendations. These rates do not account for whether shared decision making was utilized. Given the controversy surround PSA testing any screening performed without shared decision making should be considered a low-value test and thus these rates are likely even higher. With continued focus on the debate concerning whether to screen, less emphasis is on providing clinicians who are regularly testing with clear guidance on how to implement a higher-value PSA-based PCa screening program. If providers begin to perform more screening with adoption of the new USPSTF guidelines, additional growth of low-value testing may occur [20]. Much of the scientific literature over the last several decades regarding PSA-based prostate cancer screening focuses on whether or not to screen men for prostate cancer. Two large randomized prostate cancer screening trials, the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) and the European Randomized Study of Screening for Prostate Cancer (ERSPC) found conflicting levels of evidence supporting PSA screening. However, the PLCO has been widely criticized for the significant contamination of PSA testing in its control arm and recent. Additionally, updates from the ERSPC show a stronger reduction in mortality with extended follow-up and there has been an increase in utilization of active surveillance. In light of these findings the USPSTF has released new recommendations for PSA-based screening which changes their recommendation to Grade C (recommend in selected men) in men age 55–69 [4]. This new designation may result in increased interest regarding screening [20]. This USPSTF recommendation now aligns with the many professional organizations (American Urologic Society, American Cancer Society, National Comprehensive Cancer Network, etc.) that have continued to recommend PSA-based screening in specific age groups [[1], [2], [3],5].