Implementation of a Novel PSA Screening Algorithm

The Problem

In 2012, the US Preventive Services Task Force (USPSTF) issued the lowest recommendation grade (grade D) to PSA screening stating that the risks outweigh the benefits due to over-diagnosis and overtreatment. However, the USPSTF recommendation did not account for populations at high risk for prostate cancer such as African-American men and those with a positive family history. In aggregate, these disparate recommendations led to increased confusion and variation in primary care provider practice around prostate cancer screening.

The Solution

In response to these challenges, the Duke Cancer Institute’s Prostate Cancer Working Group designed a novel evidence-based PSA screening algorithm. This algorithm helps to standardize Duke’s approach to prostate cancer screening and evaluation and was tailored to the needs of the North Carolina male population which includes more than 20-30% African American men. However, it was still necessary to inform and educate primary care physicians (PCPs) of the new algorithm and to facilitate its seamless implementation and utilization within the electronic health record.

Site Principal Investigator: Kevin Pradip Shah, MD, MBA

Site Sub-Investigator: Kevin Oeffinger, MD

Impact

Inclusion of the novel PSA screening algorithm into the EHR in a manner that prompts PCPs to consider PSA screening when willing patients present with certain parameters (age, race, etc). The EHR also includes a link to the full algorithm that PCPs can use in real time during the visit. Educational presentations at numerous Duke-affiliated PCP clinics. During these educational sessions, PCPs received information on the rationale behind the new PSA algorithm, who the men are who will benefit most, and how it should be implemented.

Publications

• Aminsharifi A, Schulman A, Anderson J, Fish L, Oeffinger K, Shah K, Sze C, Tay KJ, Tsivian E, Polascik TJ. Primary care perspective and implementation of a multidisciplinary, institutional prostate cancer screening algorithm embedded in the electronic health record. Urol Oncol. 2018 Nov;36(11):502.e1-502.e6. doi: 10.1016/j.urolonc.2018.07.016. Epub 2018 Aug 28. PMID: 30170982.
• Michael ZD, Kotamarti S, Arcot R, Morris K, Shah A, Anderson J, Armstrong AJ, Gupta RT, Patierno S, Barrett NJ, George DJ, Preminger GM, Moul JW, Oeffinger KC, Shah K, Polascik TJ; Duke Cancer Institute Planning Committee for Prostate Cancer Screening. Initial Longitudinal Outcomes of Risk-Stratified Men in Their Forties Screened for Prostate Cancer Following Implementation of a Baseline Prostate-Specific Antigen. World J Mens Health. 2022 Aug 16. doi: 10.5534/wjmh.220068. Epub ahead of print. PMID: 36047079.
• Shah A, Polascik TJ, George DJ, Anderson J, Hyslop T, Ellis AM, Armstrong AJ, Ferrandino M, Preminger GM, Gupta RT, Lee WR, Barrett NJ, Ragsdale J, Mills C, Check DK, Aminsharifi A, Schulman A, Sze C, Tsivian E, Tay KJ, Patierno S, Oeffinger KC, Shah K. Implementation and Impact of a Risk-Stratified Prostate Cancer Screening Algorithm as a Clinical Decision Support Tool in a Primary Care Network. J Gen Intern Med. 2021 Jan;36(1):92-99. doi: 10.1007/s11606-020-06124-2. Epub 2020 Sep 1. PMID: 32875501; PMCID: PMC7858708.