Abstract: PD07-06
Sources of Funding: The Hitchcock Foundation

Introduction

The Dartmouth Atlas has reported wide regional variation in PSA screening and diagnosis of prostate cancer. However, the relationships between screening, diagnosis, and intervening biopsy have not been explored. In this study, we evaluated regional relationships between these events.

Methods

We performed a cross-sectional analysis of a 100% Medicare fee-for-service sample from 2012, including men aged 68 years or older. The unit of analysis was hospital referral region (HRR) (n=306). Regional rates of PSA screening, prostate biopsy, prostate cancer diagnosis were calculated, adjusting for age and race. Correlation coefficients were calculated between these events. Regions were stratified by quartile for each practice, and those with concordant or discordant practices were identified (e.g. for screening and biopsy: high/high, high /low, low/high, low/low).

Results

There was wide regional variation in all events. PSA screening rates ranged from 13-30% (mean 21.7%), biopsy 0.03-0.8% (0.18%),diagnosis 0.4-2.2% (1.0%). Overall, PSA screening did not correlate with biopsy (r=-0.04; p=0.40) or treatment (r=-0.06; p=0.29), but did weakly correlate withdiagnosis (r=0.17; p=0.003). Biopsy correlated moderately with diagnosis (r=0.33; p<0.0001). There was a wide range of concordant and discordant practices among regions.

Conclusions

Practice patterns in the screening, biopsy, and diagnosis of prostate cancer vary throughout the United States (>2-fold, >20-fold, and >5-fold from lowest to highest region, respectively). Overall, PSA screening rates were independent of biopsy or treatment, implying that screening does not necessarily lead to a cascade of procedures. While biopsy and diagnosis correlated overall, there were multiple regions with discordant practice patterns. Further study of factors underpinning variation, and outcomes associated with different practice patterns, is needed to improve care quality and increase standardization of practice._x000D_ _x000D_ _x000D_ _x000D_

Funding

The Hitchcock Foundation