National trends in the use of PSA, urinalysis, and digital rectal exam for evaluation of lower urinary tract symptoms in
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ORIGINAL ARTICLE
National trends in the use of PSA, urinalysis, and digital rectal exam for evaluation of lower urinary tract symptoms in men James Doolin1 · Zachary A. Reese1 · Kenneth J. Mukamal1 Received: 8 April 2020 / Accepted: 13 May 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The purpose of this study was to describe the practices of primary care physicians (PCPs) and urologists in their implementation of the 2010 American Urological Association (AUA) recommendations for the management of benign prostatic hyperplasia (BPH) in a nationally representative sample. Methods Data collected from 2008 to 2015 in the National Ambulatory Medical Care Survey (NAMCS) were used. Men aged 45 and older who presented with either a new complaint or exacerbation of lower urinary tract symptoms (LUTS) were included. Primary outcomes were the prevalence and determinants of prostate-specific antigen (PSA) testing, urinalysis (UA), and digital rectal exam (DRE), as all three were included in the AUA guidelines during the time period studied. In logistic regression analyses weighted to reflect national estimates, potential determinants of adherence for each testing modality were examined. Results Between 2008 and 2015, 878 visits met inclusion criteria, corresponding to 14,399,121 ambulatory visits for new or exacerbated LUTS. Weighted prevalence estimates were 24% for PSA testing (95% CI: 19–29%), 61% for urinalysis (95% CI: 56–66%), and 18% for DRE (95% CI: 15–23%). Age ≥ 75 years was associated with lower prevalence of testing for all three tests, and region was associated with different testing estimates for PSA and UA. Patients referred to urologists were more likely to receive a DRE, although overall rates of DRE decreased per additional year of data. Conclusions Adherence to AUA guidelines for evaluation of LUTS in ambulatory visits was low in a nationally representative sample of Americans, particularly for PSA testing and DRE, suggesting substantial discordance between guidelines at the time and practice patterns. Practice patterns also differed by age and region. These discrepancies encourage increased education of providers in the implementation of the guidelines, particularly since they have been updated recently. Keywords Lower urinary tract symptoms · Health care surveys · Delivery of health care · Diagnostic techniques · PSA
Introduction LUTS are common in men, encompassing problems with urine storage and voiding. The onset is most often related to development of benign prostatic hyperplasia (BPH). BPH affects approximately half of men at age 50 years and increases with age to affect more than 75% of men aged 70 and older [1]. By one estimate, in the US in 2015, 12.2 million men received active treatment for LUTS [2]. LUTS are most commonly encountered and managed by primary care physicians and urologists. In this * Zachary A. Reese [email protected] 1
Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, USA
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