Electronic medical records could help identify patients at risk for prostate cancer
MedWire News: Electronic medical records (EMRs) could improve the identification of men at risk for developing prostate cancer by triggering an evaluation in patients with identifiable risk factors, study result show.
A review of outpatient EMRs held at the University of Texas Southwestern (UTSW) Medical Center in Dallas, USA, showed that while a significant number of men are being screened for prostate cancer by non-urologist physicians, some patients with elevated prostate-specific antigen (PSA) levels (>2.5 ng/ml) are not referred to a urologist despite their increased risk for prostate cancer.
"Our goal is to prospectively use our EMR to identify patients with elevated PSA and then notify physicians individually regarding abnormal PSA results," say Yair Lotan (UTSW Medical Center) and colleagues.
"We will then be able to determine whether this reduces the number of patients who do not have appropriate discussion of their prostate cancer risks," they add.
The team assessed the clinical management of 195 patients with elevated PSA levels recorded in EMRs since March 2009, when the American Urological Association released an updated PSA Best Practice Statement recommending urologist referral for patients with PSA levels of at least 2.5 ng/ml.
The men's last recorded PSA level, any PSA rises since entering the EMRs, and their PSA velocity, as well as their age and family history of prostate cancer were included in the review.
On the basis that men with a life expectancy of at least 15 years (those aged 40-60 years) would most likely benefit from a urological consultation, 61% of the cohort should have been referred, note Lotan et al.
However, while 11 patients were referred to urology, there was no evidence that they saw a urologist, and the remaining 184 patients were not referred to, or seen by a urologist at all.
Furthermore, 24 men had a family history of prostate cancer, and 151 men had multiple PSA values recorded in the EMR, 103 of whom were found to have experienced a median 0.53 ng/ml increase between the most recent readings.
"As such, one would expect that some of these patients may harbor clinically significant disease," suggest the researchers, in the journal Prostate Cancer and Prostatic Diseases.
"EMR can be helpful in identifying patients at risk and may improve prostate cancer detection," they conclude.
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By Sarah Guy