Use of prostate-specific antigen testing as a disease surveillance tool following radical prostatectomy

Authors

  • Laurel Clayton Trantham PhD,

    1. Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, North Carolina
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  • Matthew E. Nielsen MD, MS,

    1. Division of Urology, Department of Surgery, University of North Carolina at Chapel Hill
    2. UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
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  • Lee R. Mobley PhD,

    1. Institute of Public Health, Georgia State University, Athens, Georgia
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  • Stephanie B. Wheeler PhD,

    1. Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, North Carolina
    2. UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
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  • William R. Carpenter PhD,

    1. Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, North Carolina
    2. UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
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  • Andrea K. Biddle MPH, PhD

    Corresponding author
    1. Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, North Carolina
    • Corresponding author: Andrea K. Biddle, MPH, PhD, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB 7411, Chapel Hill, NC 27599-7411; Fax: (919) 966-3671; andrea.biddle@unc.edu

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Abstract

BACKGROUND

Prostate-specific antigen (PSA) testing is recommended every 6 to 12 months for the first 5 years following radical prostatectomy as a means to detect potential disease recurrence. Despite substantial research on factors affecting treatment decisions, recurrence, and mortality, little is known about whether men receive guideline-concordant surveillance testing or whether receipt varies by year of diagnosis, time since treatment, or other individual characteristics.

METHODS

Surveillance testing following radical prostatectomy among elderly men was examined using Surveillance, Epidemiology, and End Results cancer registry data linked to Medicare claims. Multivariate logistic regression was used to examine the effect of demographic, tumor, and county-level characteristics on the odds of receiving surveillance testing within a given 1-year period following treatment.

RESULTS

Overall, receipt of surveillance testing was high, with 96% of men receiving at least one test the first year after treatment and approximately 80% receiving at least one test in the fifth year after treatment. Odds of not receiving a test declined with time since treatment. Nonmarried men, men with less-advanced disease, and non-Hispanic blacks and Hispanics had higher odds of not receiving a surveillance test. Year of diagnosis did not affect the receipt of surveillance tests.

CONCLUSIONS

Most men receive guideline-concordant surveillance PSA testing after prostatectomy, although evidence of a racial disparity between non-Hispanic whites and some minority groups exists. The decline in surveillance over time suggests the need for well-designed long-term surveillance plans following radical prostatectomy. Cancer 2013;119:3523–3530.. © 2013 American Cancer Society.

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