title: Prevalence of delayed clinician response to elevated prostate-specific antigen values.
abstract: OBJECTIVE
  To assess the frequency of delayed response to an abnormal prostate-specific antigen (PSA) value.
  
  
  METHODS
  Retrospective review of prostate cancer cases diagnosed between January 1, 2000, and December 31, 2005, in a rural Department of Veterans Affairs health care system serving 44,000 veterans across 2 states. Clinician response was defined as a reference to the elevated PSA result in clinical notes, orders for further evaluation, treatment of presumed prostatitis, or a urology visit or referral. Delay was measured as days between an abnormal PSA result and clinician response.
  
  
  RESULTS
  We identified 327 men who met inclusion criteria with an abnormal PSA value before prostate cancer diagnosis. At first PSA elevation, median age was 64 years; 94% were younger than 75 years. Of the 327 men, 253 (77.4%) had a timely (< or =30 days) response to an abnormal PSA value; 23 (7.0%) had between 31 and 180 days; 24 (7.3%), between 181 and 360 days; and 27 (8.3%), more than 360 days between an abnormal PSA measurement and clinician response. The delayed group had nearly an additional year's (309 days) lapse before completed urologic consultation and prostate gland biopsy (313 days) as compared with the timely group. The presence of urologic symptoms, abnormal results from rectal examination, higher PSA values, and higher PSA velocity (P<.05) were associated with timely clinician response to an abnormal PSA measurement.
  
  
  CONCLUSIONS
  In a cohort of men with prostate cancer and an antecedent abnormal PSA value, 15.6% had more than 180 days between an abnormal PSA measurement and clinician response. These findings add to the growing literature demonstrating that missed results occur more frequently than is generally appreciated. Improved systems for clinical data management are needed.
authors.affiliation: Department of Urology, University of Iowa, Iowa City, IA, USA.
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Nepple
authors.forename: Fadi N
authors.initials: FN
authors.lastname: Joudi
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Hillis
authors.forename: Terry L
authors.initials: TL
authors.lastname: Wahls
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D003951:Diagnostic Errors; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D012189:Retrospective Studies; D012424:Rural Population; D012720:Severity of Illness Index; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D017430:Prostate-Specific Antigen