TY - JOUR
T1 - Rates of False-Negative Screening in Prostate Specific Antigen Secondary to 5-Alpha Reductase Inhibitor Usage
T2 - A Quality-Improvement Initiative
AU - Loloi, Justin
AU - Wei, Matthew
AU - Babar, Mustufa
AU - Zhu, Denzel
AU - Fram, Ethan B.
AU - Maria, Pedro
N1 - Publisher Copyright:
© 2022, International Braz J Urol.All Rights Reserved.
PY - 2022/7
Y1 - 2022/7
N2 - Purpose: Patients often take 5-alpha reductase inhibitors (5-ARIs) for the management of benign prostatic hyperplasia. However, 5-ARIs can decrease prostate specific antigen (PSA) by approximately half and therefore may lead to false negative PSA tests. We investigated false-screening rates in men on 5-ARIs undergoing PSA testing and whether ordering physicians noticed false negative findings. Materials and Methods: A single institution, retrospective study was conducted on patients with a PSA value documented between 2014 and 2017. Patient demographics, PSA results, 5-ARI usage, and providing clinician characteristics were collected. Published normal PSA values were used to determine PSA test positivity; values for those on 5-ARIs were doubled. Results: A total of 29,131 men were included. 1,654 (5.7%) were prescribed 5-ARIs at least 12 months prior to PSA evaluation. 118 men (7.1%) had a value that would be positive if corrected for 5-ARI usage, 33 (27.9%) of which had no indication that the provider had noted this. There was no effect on rates of false negative values if the PSA was ordered by a different provider than the one who prescribed the 5-ARI (p = 0.837). However, if the provider who ordered the PSA test was an urologist, the likelihood that a false negative value would be identified was lower (p=0.001). Conclusions: More than a quarter of men with false negative tests were missed. This occurred more often when the ordering provider was not an urologist.
AB - Purpose: Patients often take 5-alpha reductase inhibitors (5-ARIs) for the management of benign prostatic hyperplasia. However, 5-ARIs can decrease prostate specific antigen (PSA) by approximately half and therefore may lead to false negative PSA tests. We investigated false-screening rates in men on 5-ARIs undergoing PSA testing and whether ordering physicians noticed false negative findings. Materials and Methods: A single institution, retrospective study was conducted on patients with a PSA value documented between 2014 and 2017. Patient demographics, PSA results, 5-ARI usage, and providing clinician characteristics were collected. Published normal PSA values were used to determine PSA test positivity; values for those on 5-ARIs were doubled. Results: A total of 29,131 men were included. 1,654 (5.7%) were prescribed 5-ARIs at least 12 months prior to PSA evaluation. 118 men (7.1%) had a value that would be positive if corrected for 5-ARI usage, 33 (27.9%) of which had no indication that the provider had noted this. There was no effect on rates of false negative values if the PSA was ordered by a different provider than the one who prescribed the 5-ARI (p = 0.837). However, if the provider who ordered the PSA test was an urologist, the likelihood that a false negative value would be identified was lower (p=0.001). Conclusions: More than a quarter of men with false negative tests were missed. This occurred more often when the ordering provider was not an urologist.
KW - 5-alpha reductase inhibitors
KW - Prostate-specific antigen
KW - Prostatic hyperplasia
KW - Prostatic neoplasms
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U2 - 10.1590/S1677-5538.IBJU.2022.0099
DO - 10.1590/S1677-5538.IBJU.2022.0099
M3 - Article
C2 - 35594325
AN - SCOPUS:85130864399
SN - 1677-5538
VL - 48
SP - 688
EP - 695
JO - International Braz J Urol
JF - International Braz J Urol
IS - 4
ER -