Racial and Ethnic Variation in Time to Prostate Biopsy After an Elevated Screening Level of Serum Prostate-specific Antigen.
OBJECTIVE
To examine the racial and ethnic variation in time to prostate biopsy after an elevated screening level of serum prostate-specific antigen (PSA).


METHODS
Male members of the Kaiser Permanente of Southern California health plan, 45 years of age or older, with no history of prostate cancer or a prostate biopsy, and at least 1 elevated screening level of serum PSA between January 1, 1998 and December 31, 2007 were retrospectively identified (n = 59,506). All participants were passively followed via electronic health records until their time of prostate biopsy, death, membership disenrollment, or study conclusion (December 31, 2014), whichever was the initial event. Proportional hazard regression analyses were used to estimate the association between time from an elevated screening level of serum PSA to prostate biopsy, adjusting for age, benign prostatic hyperplasia, prostatitis, type 2 diabetes mellitus, hypertension, and Charlson Comorbidity Index score.


RESULTS
Median time until biopsy was 0.6 years (214 days), with approximately 41% of participants receiving a prostate biopsy within the study period. Results from the fully adjusted analysis indicated that the non-Hispanic Asian or Pacific Islanders (hazard ratio: 1.10, 95% confidence interval: [1.04, 1.15]) and the non-Hispanic blacks (hazard ratio: 1.04, 95% confidence interval: [1.00, 1.08]) had a slightly shorter time to prostate biopsy after an elevated screening level of serum PSA compared to the non-Hispanic whites.


CONCLUSIONS
These data suggest that, within an integrated healthcare organization, minimal differences exist between racial and ethnic subgroups in their time to prostate biopsy after an elevated screening level of serum PSA.
Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena, CA.
Stephanie R
SR
Reading
Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena, CA.
Kimberly R
KR
Porter
Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena, CA.
Jin-Wen Y
JY
Hsu
Department of Medicine and Epidemiology, University of Michigan, Ann Arbor, MI.
Lauren P
LP
Wallner
Department of Urology, Kaiser Permanente of Southern California, Los Angeles, CA.
Ronald K
RK
Loo
Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena, CA. Electronic address: Steven.J.Jacobsen@kp.org.
Steven J
SJ
Jacobsen
D000368:Aged; D001706:Biopsy / Q000706:statistics & numerical data; D005006:Ethnicity; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology*; D044469:Racial Groups; D012189:Retrospective Studies; D013997:Time Factors
D017430:Prostate-Specific Antigen