title: The effect of lowering the prostate-specific antigen normal cutoff on referral rates to urology.
abstract: BACKGROUND
  Routine prostate cancer screening is controversial, yet the use of prostate-specific antigen (PSA) for screening is likely to continue. Our hospital laboratory decreased the cutoff for normal PSA to 2.5 ng/mL on July 2, 2007, based on the National Comprehensive Screening Network recommendations. The purpose of this study was to determine if referral rates to urology increased after this change.
  
  
  METHODS
  We queried our electronic health records to obtain the number of total screening PSA and abnormal PSA and subsequent referrals to urology in the 20-month periods before and after the change in PSA cutoff.
  
  
  RESULTS
  There was no significant difference between the percentage of total screening PSA that resulted in a referral to urology after the change than before (7 of 199 [3.5%] vs 8 of 113 [7.1%]; P = .16). The percentage of abnormal PSA (as defined in the respective time periods) that were referred to urology actually decreased after the change (7 of 29 [24.1%] vs 6 of 10 [60.0%]; P = .04); however, when considering only PSA >4.0 ng/mL in each time period, there was no difference in percentage of referrals between the 2 periods.
  
  
  CONCLUSIONS
  Contrary to expectations, lowering the cutoff for normal PSA did not increase referrals to urology.
authors.affiliation: Department of Family Medicine and Community Health, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Freehold, NJ 07728, USA. bshenker@centrastate.com
authors.forename: Bennett S
authors.initials: BS
authors.lastname: Shenker
authors.forename: Julie
authors.initials: J
authors.lastname: Stern
mesh_terms: D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards*; D057286:Electronic Health Records; D006801:Humans; D008297:Male; D009515:New Jersey; D017410:Practice Guidelines as Topic; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis*; D012015:Reference Standards; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D014572:Urology
chemical_list: D017430:Prostate-Specific Antigen