The impact of Race and physician's specialty on performing work-up in patients first tested with a PSA > 4 ng/ml

Document Type

Conference Proceeding

Publication Date

3-1-2026

Publication Title

Eur Urol

Keywords

Urology & Nephrology

Abstract

Introduction & Objectives: International guidelines have always clearly established that a patient with an elevated PSA (≥4 ng/ml) needs further diagnostic work-up, either in search of malignancy or to address a benign/inflammatory condition. Nevertheless, some patients with abnormal PSA values are not appropriately worked-up with limited data available in literature on this topic. In this context, socioeconomic factors as well as healthcare facilities accessibility may play an important role in patient's correct diagnostic pathway. To address this void, we our aim was to examine the percentage of patients with elevated PSA undergoing appropriate diagnostic evaluation and to investigate the determinants influencing adherence to recommended care. Materials & Methods: We included patients who received a PSA test at one of Henry Ford Health System facilities between 1995 and 2023 and who resulted with a PSA >4 ng/ml. The primary endpoint was receipt of an Appropriate Diagnostic Work-Up, defined as repeat PSA within 6 months and/or MRI or biopsy within 12 months after the abnormal result. Under this premise, patients with less than 1 year of follow-up were excluded from the analysis. A multivariable logistic regression assessed predictors of appropriate work-up, including PSA value, age, race, Charlson Comorbidity Index (CCI), socio-economic status and PSA ordering department. Results: Of 26,505 patients, less than half (45.6%) received an Appropriate Diagnostic Work-Up. Median PSA was 5.3 (IQR 4.5 – 7.2) ng/ml and median age was 65 (IQR 59-70) years. Compared to their counterpart, patients who received appropriate work-up had higher median PSA (5.6 ng/ml [IQR 4.6-7.9] vs 5.1 ng/ml [IQR 4.4-6.7]), were younger (median age: 64 [58-69] vs 65 [59-70] years old), more frequently Black (33.9% vs 25.7%) and more likely to be seen by an urologist prior to the PSA test (4.4% vs 7.2%, all p<0.001). At the multivariable analysis, Black patients had 1.4-fold higher likelihood of getting appropriate work-up than their White counterparts. Conversely, patients seen by Internal-Family Medicine provider were 39% less likely to get appropriate work-up respect to their counterparts seen by the Urologist (OR 1.40 [1.32-1.49] and OR 0.61 [0.54-0.68], both p< 0.01). Conclusions: Less than half of patients with elevated PSA received an appropriate diagnostic work-up, revealing substantial gaps in post-test care. Our results highlight the need for clearer care pathways, better provider education, and system-level interventions to ensure timely and equitable management of patients with abnormal PSA results.

Volume

89

First Page

1

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