Background

Prostate cancer is a leading cause of cancer death among US men. However, risk of death from prostate cancer can be reduced through early detection, including screening done via a prostate-specific antigen test (PSA), and subsequent treatment of early-stage disease. Black men have an elevated risk of developing more severe forms of prostate cancer at an earlier age; they are also at a higher risk of dying from the disease. One possible reason suggested for this disparity is that Black men may be less likely to receive and complete timely follow-up with urology specialists for additional assessment and treatment following a PSA test with abnormal findings.

What We Did

To understand this disparity, we analyzed patient data collected in the Duke University Health System. Duke Health uses an algorithm that incorporates patient data on age and race to determine whether additional follow-up including referral to urology is needed after an abnormal PSA test result. We examined rates of referral for men aged 40-75 who were seen by Duke Health clinicians and had elevated test values following a PSA screening. We looked at the different characteristics of these patients and analyzed patterns that might give us insights into patterns of referral for urology appointment and completions of those referrals, as well as the amount of time between referral and completion.

When we analyzed this Duke Health data, we found that Black men were more likely to receive a urology referral after abnormal PSA, a finding that aligns with the Duke Cancer Institute’s PSA screening guidance. However, we also found that Black men were somewhat less likely to complete those referrals, even after we adjusted the data to account for variables such as age, insurance status, and distance from the referral provider.

Next Steps

We plan to conduct additional, in-depth analyses to better understand the factors driving these lower rates of referral completion among Black men and develop approaches that help ensure that all men with elevated PSA tests are receiving appropriate follow-up care. We also plan to look at the quality of care processes after referral, including time to diagnosis, time to treatment, and outcomes after treatment. We are currently applying for additional grant funding from the American Cancer Society to help support this work.