UPJ INSIGHT Predictors of Timely and Delayed Evaluation After Referral for Elevated PSA in a High-risk Population

By: Rutul D. Patel, DO, Montefiore Medical Center, Bronx, New York; Michael Zhu, MS, Albert Einstein College of Medicine, Bronx, New York; Priya Dave, MD, Montefiore Medical Center, Bronx, New York; Ilir Agalliu, MD, Montefiore Medical Center, Bronx, New York; Quoc-Dien Trinh, MD, Brigham and Women’s Hospital, Boston, Massachusetts; Kara L. Watts, MD, Montefiore Medical Center, Bronx, New York, Albert Einstein College of Medicine, Bronx, New York | Posted on: 20 Jul 2023

Patel RD, Zhu M, Dave P, Agalliu I, Trinh Q-D, Watts KL. Predictors of timely and delayed urological evaluation following referral for elevated prostate-specific antigen in a diverse, urban, high-risk population. Urol Pract. 2023;10(4):353-359.

Study Need and Importance

An elevated prostate-specific antigen (PSA) often prompts a referral to urologists for further evaluation. Delayed, or even absent, urological evaluation can potentially lead to a delay in diagnosis of prostate cancer. Identifying patient-specific characteristics that are associated with timely urological evaluation in men with elevated PSA may inform practice changes that can help to ensure appropriate follow-up for men identified with an elevated PSA.

What We Found

We retrospectively reviewed data from 1,335 men who were referred to urology for initial elevated PSA and categorized their time to initial urological evaluation as either timely (within 4 months of referral), late (after 4 months), or absent (no urology evaluation). Multivariable logistic regression showed that being non-Hispanic Black, Hispanic, Spanish-speaking, or a former smoker increased odds of timely urological evaluation.


Our limitations include the retrospective nature of our study resulting in an inability to assess certain variables, such as reason for absent urological evaluation or whether men sought evaluation outside of our health care system. Furthermore, we were unable to confirm whether urological care was provided outside of our health care network.

Interpretation for Patient Care

In our urban, highly diverse cohort, non-Hispanic White men and English-speaking men demonstrate a vulnerability to delayed urological evaluation following elevated PSA referral. Recognizing patient-specific factors that limit timely follow-up can help referring physicians be more proactive in their goal to provide timely and equitable care.