Predictors of Timely and Delayed Urological Evaluation Following Referral for Elevated Prostate-specific Antigen in a Diverse, Urban, High-risk Population

Introduction:This study aimed to evaluate predictors of timely urological evaluation among men referred for initial elevated PSA in a diverse, high-risk, urban community.Methods:We conducted a retrospective cohort study of all men aged 50+ referred to urology within our healthcare network between January 2018 and December 2021 for initial elevated PSA. Time to initial urological evaluation was categorized as timely (within 4 months of referral), late (after 4 months), or absent (no urology evaluation). Demographic and clinical variables were abstracted. A multivariable multinomial logistic regression model was conducted to identify predictors of timely vs late vs absent urological evaluation controlling for age, referral year, household income, distance to care, and PSA at referral.Results:A total of 1,335 men met inclusion criteria; 589 (44.1%), 210 (15.7%), and 536 (40.1%) had timely, late, and absent urological evaluation, respectively. The majority were non-Hispanic Black (46.7%), English-speaking (84.0%), and married (54.6%). Median time to initial urological evaluation differed significantly between timely and late groups (16 vs 210 days, P <.001). Multivariable logistic regression revealed the following to be significant predictors of timely urological evaluation: non-Hispanic Black (OR=1.59, P =.03), Hispanic (OR=2.07, P =.001), Spanish-speaking (OR=1.44, P =.03), or former-smokers (OR=1.31, P =.04).Conclusions:In our diverse community, men who are non-Hispanic White or English-speaking have a decreased odds of timely urological evaluation after a referral for elevated PSA in our diverse patient population. Our study underscores cohorts that may benefit from implementation of institutional safeguards such as patient navigation systems to facilitate and ensure appropriate follow-up upon referral for elevated PSA.