Rates of False-Negative Screening in Prostate Specific Antigen Secondary to 5-Alpha Reductase Inhibitor Usage: A Quality-Improvement Initiative

Justin Loloi, Matthew Wei, Mustufa Babar, Denzel Zhu, Ethan B. Fram, Pedro Maria

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)688-695
Number of pages8
JournalInternational Braz J Urol
Volume48
Issue number4
DOIs
StatePublished - Jul 2022

Keywords

  • 5-alpha reductase inhibitors
  • Prostate-specific antigen
  • Prostatic hyperplasia
  • Prostatic neoplasms

ASJC Scopus subject areas

  • General Medicine

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